Whole Brain Radiation retreatment - 1262192

chaioni
Posts:3

Hi,
My mum has adenocarcinoma with mets to brain treated with WBR in Dec 2012.
Since then she has had good quality of life and little permanent damage. Her brain mets have recently returned. There are multiple wide spread small lessions with small amount of oedema.
We are in the process of evaluation if gamma knife is possible. A second option discussed is repeat of WBR over 10 days with a lower dose than her first treatment. My question is: Is there any data on the satefy and effectiveness of repeat Whole brain radiation?
Ch

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Reply # - February 10, 2014, 05:48 AM

JimC
Posts: 2753

I'm sorry to hear of your mum's brain met recurrence. My wife and I had faced the same decision about repeat WBR, although in her case she also had significant progression elsewhere in her body. In response to my questions, Dr. West said:

"...repeat WBR is never something we'd undertake lightly, but I've done it, sometimes with very good results (I have a patient two years out from second WBR for lung cancer who I saw last week and continues to do well, with no changes in her head MRI just completed, terrific cognitive function (no complaints and clearly as smart as just about anyone), and who also had repeat WBR after less than a year from her first go-round with it. Certainly not a guarantee, but it gives an idea of what's possible. In this situation of multifocal relapsed brain mets, we've had careful discussions, and I don't believe any of my patients or caregivers who went down that road of repeat WBR ever regretted their decision (and all of them that I can recall having offered decided to do it), though I would have to say that not all had terrific results." - http://cancergrace.org/forums/index.php?topic=9910.msg78833#msg78833

In the same thread, he also said

"The patients in whom we've needed to and have done repeat WBR have been few and far between -- in fact, I could count them on the fingers of one hand with digits to spare. And yes, they've been selected, because the ones who were progressing in the brain but also had a more marginal performance status left us feeling pretty convinced that a focus on supportive care was the right path to follow. It's probably misleading for me to make any general statements about what happened with 3 or 4 patients over the past 7-8 years. I mentioned that I have one who did and continues to do well, but I don't think I've had another patient who has done repeat WBR over the 18-24 months, so I just don't think it's feasible to speak to much beyond what's possible. I wouldn't want to make a hard sell. [continued]

Reply # - February 10, 2014, 05:49 AM

JimC
Posts: 2753

[continued from previous post]

" don't recall a patient debilitated by side effects from it, but we're covering so few patients over so many years that I just can't recall many details of the courses of many patients going back more than the past 3-5 years.

To me, the key issue is whether the pace of disease seems set more by the intracranial than extracranial disease. In that sense, if liver metastases are growing faster than brain lesions, I think it makes a strong argument for focusing more on the systemic management. And again, this is presuming that a person is both feeling well enough to pursue more treatment and is motivated to do it, for unclear benefit."

Good luck with whatever path is chosen.

JimC
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