Complications following whole brain radiation - 1263445

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Complications following whole brain radiation - 1263445

My husband is 37 with ALK+NSCLC and was recently treated with whole brain radiation therapy for several brain mets. He developed what the doctor called Jacksonian seizures in his left hand a week after his last treatment. They lasted three days and have improved after resuming decadron. However, he has experienced increasing weakness in his left hand to the point that he drops things and can't use it very well for dressing, etc. To complicate things further, he developed a blood clot in his internal jugular vein and subclavian in the left side the week before the wbr which is still causing swelling and could be playing a role. He is being treated with Lovenox. Are these symptoms likely to improve or be permanent, and is there any way to prevent further decline? Our doctors don't seem to feel much urgency, but we know that issues such as stroke can be time sensitive. Thank you for your input.

Reply To: Complications following whole brain radiation

Hi cristyd,

Welcome to GRACE. If the seizures are being caused by brain mets and their associated swelling within the brain, and decadron has helped by reducing that swelling, it is certainly possible that the whole brain radiation your husband received will clear those brain mets and the problem will subside. WBR does not immediately kill the cancer cells; that happens over a period of weeks. That explains his doctors' lack of urgency; they know that the WBR was done to kill the cancer cells over time, while in the short term the decadron reduces the swelling and minimizes or eliminates symptoms. As the American Cancer Society states on its page about radiation treatment:

"Radiation works by damaging the genes (DNA) in cells. Genes control how cells grow and divide. When radiation damages the genes of a cancer cell, it can’t grow and divide any more. Over time, the cells die.
Radiation does not always kill cancer cells or normal cells right away. It might take days or even weeks of treatment for cells to start dying, and they may keep dying off for months after treatment ends. Tissues that grow quickly, such as skin, bone marrow, and the lining of the intestines are often affected right away. In contrast, nerve, breast, brain, and bone tissue show later effects. "

Of course if the blood clot is playing a role, then his doctors will be looking to the Lovenox to resolve that issue.

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Dr West
Reply To: Complications following whole brain radiation

The WBR is an appropriate treatment for the multiple brain metastases, and the lovenox is appropriate treatment for the blood clots. Beyond that, there really isn't anything that is indicated. There isn't evidence to say it's appropriate to treat for a stroke without clear evidence of a stroke.

Unfortunately, there's no way to know exactly how much the symptoms will improve or resolve, though there's reason to be hopeful that they will.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education