Timing of Gamma Knife Treatment for Small Brain Mets - 1249225

laya d.
Posts:714

Generally speaking, what is an acceptable amount of time to wait for Gamma Knife treatment for small sub-centimeter brain mets which are not causing a whole lot of symptomology RIGHT NOW (some pressure, a bit of a headache, etc.)?

To give some context, my Mom's case was brought before the tumor board and it was decided that she should have the two small mets (6mm and 3mm) discovered 2 days ago gamma-knifed (no apparent involvement of the meningies, thank goodness). Due to the neurosurgeon being out of town and other back-log scheduling issues, the earliest appointment they can give us right now is November 6, 2012 (19 days from now). This seems like an awfully long time to me (and makes me think that the mets potentially could double). The 6mm met is of particular concern because it is in an area very close to the cerebral fluid and I'm concerned that if we wait and this thing grows, it will break through the pia and get into the cerebral fluid. It also is very close to the optical nerve. Is waiting 3 weeks to get gamma knife to known brain mets in this setting reasonable?

I'm super worried about this and am at a loss as to what we should do.

Laya

Forums
Full Archive

Reply # - October 18, 2012, 07:14 PM

JimC
Posts: 2753

Laya,

I am sorry to hear of this situation and I completely understand your concern. I don't know that trying to get a second opinion would help, since you might not be able to get in to see someone any quicker that way (unless you already have a relationship with another institution from a prior second opinion). Personally speaking, I would put a great deal of pressure on her doctors/hospital to move that appointment up. Your mom's brain mets are small but I don't think it ever makes sense to wait to treat them because of what I have seen of their effects.

I have also forwarded your question to the GRACE faculty for response.

I hope you can get the treatment moved up, if for no other reason than to relieve your worry about it.

JimC
Forum moderator

Reply # - October 18, 2012, 08:25 PM

Dr West
Posts: 4735

It's a little on the long side, but it's really only a difference of about 7-10 days from a more typical interval. Given how extremely small these lesions are, I'd be very, very surprised if that delay would have any clinical impact on anything.

-Dr. West

Reply # - October 19, 2012, 06:56 AM

dr loiselle
Posts: 37

Hi Laya -

Sorry to hear about these, however, these two little spots should easily be controlled with Gamma Knife.

I am not too concerned about the delay to early November for treatment, though my impression depends some on how/why these were discovered.

If your Mom was having headache which prompted the scan, these spots were found and have significant/out of proportion associated edema and are thought to be causing significant symptoms, then I would push to have your Mom's neurosurgeon's covering partner help get things underway sooner.

However, if this was a scheduled surveillance scan which picked these up, there is not a lot of surrounding edema (which I would expect to be the case for such small lesions), and the association to her headache is more of a retrospective "well, she has had a little bit more of a headache lately," I would be less concerned about waiting until 11/6/12.

As well, it depends on when her last scan was... if these seem to be new over a very short interval, then I would not want to wait... if it has been 3-6 months or more since her last MRI, I again would not be concerned.

My final thought - are these symptomatic enough that she was started on dexamethasone? If so, and it depends on the dose of dexamethasone somewhat too, I would favor treating sooner rather than later. If people are otherwise doing well, I don't like to have them taking dexamethasone for weeks while waiting for a procedure - occasionally the side effects can be troublesome.

I hope that helps... please let us know if anything else we can help with.

Dr Loiselle

Reply # - October 19, 2012, 09:14 AM

laya d.
Posts: 714

Thanks so much Dr. West, cs and Jim. I really apprecite your comments and you have calmed me down a bit.

Dr. Loiselle: my mom was feeling a bit headachy and a bit nauseous on-and-off, so we moved her regular surveillance MRI up by one week when these spots were discovered. So, these have appeared since her last MRI on 7/26/12 (her more recent MRI was on Oct. 16, 2012). Her doc said that its unlikely that her headaches are because of these 2 spots (I'm assuming because there isn't a whole lot of swelling around them yet). The doctor's office is trying to get these things moved up and the gamma knife center has said that if a spot opens up between now and then, my Mom will get it. They called this morning and were able to move her up 4-days to Nov. 2nd (with a promise that they will move her up further if a spot opens up). For me, the issue is that the 6 mm spot is "at the right aspect of the interpedular cistern" and so the concern is that if it grows and breaks through the pia, it'll come into contact with the cerebral fluid (btw: this is my non-medically trained understanding of it all). So, that's why I'm wondering if waiting an additional 2 weeks is just way too long...

Thanks so much,
Laya

Reply # - October 19, 2012, 09:25 AM

dr loiselle
Posts: 37

Laya -that sounds fine. I would feel comfortable with 11/2. Again, if you mom was started on steroids because of her symptoms, I would want here to have treatment sooner rather than later (and then taper off of the steroids) because of my concern for the side effects of the steroids. Ten days or so should not make a difference in terms of her risk for CSF spread given these lesions as you have described.

Best,
Dr. Loiselle

Previous PostNext Post