Dear Drs
I had earlier contacted the forum here to seek advice towards the options to treat my dad's lesion in the femur. At that time, it was decided to wait and see if tarceva would keep things under control for him. His recent scans have shown that Tarceva's ability to keep the cancer under control has failed.
His recent MRI and CT scans have revealed that the primary tumor in his right lung has grown by 10% and shows additional nodules. He has additional bone met on his T1 vertebra (on the pedicles, so it is asymptomatic), further growth of the lesion on his femur to reach the marrow. In addition he has 16 lesions in his brain. In July 2011, he underwent Gamma knife radiosurgery to treat 13 lesions in the brain (all of them were 1-2 mm). In late August 2012, he underwent cyberknife radio surgery to treat further lesions in the brain in India. Amongst the 16 lesions detected in the present scan, some of them are from preexisting treated lesions, with one having grown to 19 mm.
I was wondering about the treatment options.
He is mentally pretty active and has no lesions in any other organs apart from the above mentioned.
Would Gamma knife therapy still be the best option to treat his brain lesions. It is expensive(no insurance) but promises little to no side effects?
We consulted another neurosurgeon, who said that repeated Gamma knife/cyber knife therapies give the brain same kind of sideeffects that a whole brain radiation therapy would give. So it would be better to treat these lesions and any other undetectable lesions in the head with whole brain radiation.
We are just worried about the side effects of whole brain radiation such as memory loss, etc.
Any input in this regard would be gratefully appreciated.
As for the lesion in the femur, a regular fractionated steriotactic radiation treatment is being proposed.
Thank you for your valuable time and assistance.
Best wishes
Arul
Radiation options: Gamma knife vs WBR - 1251039
altruist77
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Reply # - December 7, 2012, 05:49 AM
Reply To: Radiation options: Gamma knife vs WBR
Hallo Arul. I'm sorry to hear about your father. Although I am not a doctor, I have (treated) brain mets, and so have read a lot about this subject on GRACE. I think you'll find that in your father's situation, WBR is going to be the option that most doctors would suggest. Here's a quote from Dr West, in July 2012:
"It’s possible to do stereotactic radiosurgery (SRS) for patients with more than 1-3 brain lesions, but with more than that, the risk of more is quite a bit higher, and WBR is really the standard approach and what I recommend to my patients with more than 3 brain metastases. "
(This is from http://cancergrace.org/topic/whole-brain-radiation-side-effects)
It doesn't sound as if the Gamma knife/Cyberknife has worked particularly well for your father in keeping the brain mets at bay. Many people seem very afraid of the side-effects of WBR, but I personally am far more afraid of brain mets. The question of memory loss seems to depend a bit on age and on the individual, but I can testify that my own memory is more or less OK. Best to you and your dad.
Reply # - December 7, 2012, 06:20 AM
Reply To: Radiation options: Gamma knife vs WBR
I'm very sorry to hear of his progression.
I agree with every word from certain spring. When you say "would gamma knife therapy still be the best option?", I would say first that in my mind (and based on all evidence), it was never the appropriate treatment for someone with so many brain lesions. Moreover, as certain spring noted, it hasn't been an effective approach. I would consider whole brain radiation (WBR) to be the overwhelming choice here, so much so, that it is very difficult for me to think of any alternative that I would consider a feasible alternative.
I see approaches like Gamma Knife being vastly over-recommended and over-utilized, far outside of where it is well established and appropriate. This is in part because of concern of side effects of WBR, some of which is appropriate and real, but which tends to be overestimated to the point that it borders on irrational, but it's also done in part because many radiation oncologists stand to make so much more money from doing Gamma Knife procedures vs. WBR. And this is especially true when Gamma Knife actually doesn't work and they get to do more Gamma Knife procedures later, after their ineffective therapy, when WBR would have had a much greater chance of avoiding further brain metastases.
The proposed treatment for the femur lesion seems very appropriate.
-Dr. West