Side affect after Gamma Knife?? - 1264009

Dear hartstogether: I'll let those with more expertise answer your medical questions, but I want to let you know that you will feel better than you do now! You should also know that a common side effect of all the steroids is depression, so tell your primary that, and ask for advice about what to do. It's hard to keep your spirits up when you're feeling lousy, but ask for help. Ask a friend or relative to take you out for coffee, or to a movie. Walk in a park to the extent that your energy will let you. Find a funny show or movie on TV and watch it, whatever works for you to keep your spirits up, even if you don't quite feel like it. We're all pulling for you, and we've been in lousy places ourselves, and know that things do get better. I'm thinking of you, and hoping things work out with your dr. tomorrow morning.
Nan

I agree that it's very unlikely the side effects are due to gamma knife, but you've already found that getting gamma knife to brain lesions for SCLC and not doing whole brain radiation (WBR) leaves people very vulnerable to later brain metastases. We know that brain metastases are so common in SCLC that if someone already has evidence of one or more brain metastases, they are extremely likely to have more over time if they don't get WBR. So progression in the brain may be a cause.

Coming down on dose or stopping steroids might also be a cause, which can be tested by increasing the dose of steroids and seeing if things get better.

Otherwise, it's possible that progressing cancer somewhere in the body could be reducing your energy level -- this can be checked by repeating imaging if that hasn't been done in a while.

Having your salt levels out of balance, specifically having a low serum sodium level, is also common in SCLC and can lead to major fatigue, as can a calcium level that is out of range and can happen with many cancers. A simple blood test could look for that.

Fatigue can be caused by many things, alone or in combination, so your doctor will be in a better position to try to determine the most likely cause(s) of your low energy.

Good luck.

-Dr. West

Finally, radiation pneumonitis is inflammation that occurs in the lungs after chest radiation, especially combined with chemotherapy. It typically occurs weeks to months after radiation is completed and is associated with shortness of breath, a cough, sometimes a low grade fever. You can learn more about it by searching for the term in the search box at the top of the page.

-Dr. West

Finally, radiation pneumonitis is inflammation that occurs in the lungs after chest radiation, especially combined with chemotherapy. It typically occurs weeks to months after radiation is completed and is associated with shortness of breath, a cough, sometimes a low grade fever. You can learn more about it by searching for the term in the search box at the top of the page.

-Dr. West

It is true, there is a lot of of uncertainty with this disease. Personally I think that the "oligometastatic" term applies much less often to extensive stage small cell lung cancer. My understanding is that small cell is a systemic disease from the beginning, and the mainstay is systemic treatment.
Sometimes it seems like the biology of the small cell is what really determines prognosis, more than our treatment does. For example, here is a case of a woman who had a stable small cell with a brain met for 14 months with no treatment at all.
http://www.sciencedirect.com/science/article/pii/S0169500210002175

As you suggested, there are likely many contributing factors, but low blood counts and recent chemo are readily reversible ones. We routinely hold chemo for people who are too fatigued to manage their activities of daily living, as well as for those whose counts are so low that additional chemo is liable to put them at excessive risk.

There are medications like Ritalin (methlyphenidate), Provigil (modafinil), or steroids that can increase energy a bit, but it's still unwise to pursue chemotherapy when a person is too weak or blood counts are not high enough to drop without getting to very unsafe levels.

Good luck.

-Dr. West