What is prognosis of "Too numerous to count brain metastases"? - 1246110

There is certainly a range in how patients do with brain metastases. I have some patients who remain alive for literally years and have an excellent performance status (few, if any, limitations in activities, and feeling well) for a very long time. But brain metastases do confer an overall worse prognosis that is often associated with a median survival of a few months...the median being the point at which half of the patients in that group have died, and half remain alive. Meanwhile, response to the treatment in terms of both improvement in symptoms and imaging looking better are associated with a much greater chance of doing relatively well, while the opposite is true for people who are not doing much better and/or have no improvement or especially worsening of findings on imaging. It's worth noting, however, that it's not rare it to take several weeks or even possibly a couple of months to really see more significant improvement after treatment.

If she's not improving at all, and especially if she's getting worse based on either how she's doing clinically or on how her scans look, then the cancer may well be very aggressive, and her survival may be limited to weeks, I'm sorry to say. But if she turns around, there is reason to be hopeful that her survival could extend into many months and potentially a year or years.

Good luck.

-Dr. West

Hallo kelleylynn. I'm sorry about your mother.
I wanted to reinforce Dr West's point - that you wouldn't necessarily see positive changes on an MRI straightaway (it sounds as if the brain radiation only ended a few weeks ago?). Also to mention that radiation sometimes makes things worse before they get better. So it's possible that her balance problems might improve.
When you asked what to expect, your mother is going to be very tired after the radiation, especially if she's having chemotherapy as well.
I know that the idea of the mets being "too numerous to count" is very distressing. Just bear in mind that they may be very small, so it would be like trying to count stars or grains of sand. My best wishes to your mother, and to you.

Hi kelleylynn,

As certain spring pointed out, a follow up MRI done just as WBR was ending is not likely to give any information about whether the radiation was effective. The radiation used to treat cancer is not like a ray gun that melts away the cancer cells on contact; on the contrary, it can take weeks to kill the cancer cells. That can take a while to show up on a scan. You may want to have the radiation oncologist go over that process with you tomorrow so that he can give you a sense of what to expect at this point in terms of what the scan should show and how quickly to expect an improvement in symptoms.

JimC
Forum moderator

Hi kelleylynn,

I am very sorry about your mom. I just want to let you know from my experience w/my husband and his WBR that it took a little time to see the improvements after WBR. He was a stage IV NSCLC adenocarcinoma w/many brain mets also. I know it is a very scary time and I am sending best wishes to you all. You have come to a good place to gather info. Take care.

Lisa