Hi Dr. West, Janine and JimC,
I'm very confused about the interpretations we are getting regarding my dad's brain scans. Here is a brief background which I think may be helpful:
Brain MRI No. 1: March, 2014 (at time of diagnosis and staging) -- no brain disease
Brain MRI No. 2: July 2014 -- punctate lesions, likely metastatic disease
Brain MRI No. 3: August 2014 -- some punctate lesions resolved, others stable
My dad had his last chemo treatment (carbo/taxol) on May 26, 2014. No other treatment since then.
The radiologists are saying that even though some of these lesions disappeared off treatment, they still believe them to be brain disease. At this point, we are unsure if the original scan (No. 1) was interpreted correctly, as the results for scan No. 2 referred to know metastatic brain disease, i.e. I am inferring from scan No. 1 (the only other brain scan that had been done up until that point).
So, I have two questions:
1) Assuming there was brain disease at the time of diagnosis, is it possible that it shrank/remained stable from scan No. 2 to No. 3, even though my dad was well off treatment at this point. In other words, can brain tumors continue shrinkage long after chemotherapy has stopped?
2) Alternatively, if scan No. 1 was in fact clear, would there be any explanation for brain tumors spontaneously resolving (and remaining stable) between scans No. 2 and No. 3?
Thanks so much,
Tue, 08/26/2014 - 12:32
The word punctate suggests it's tiny to begin with. It's not uncommon for people to have small nonspecific spots on the brain though I'm don't know whether they have the habit of coming and going as the report suggests. Since your dad has nsclc it's possible to metastasize to the brain (squam less likely than adeno to met to brain) so the radiologist made the suggestion "likely metastatic disease".
It's not possible for us to say why the reports read the way they do. Has his onc made any suggestions about following them?
I'll ask one of our faculty to comment.
How is your dad feeling. I hope he's able to enjoy better health post treatment.
Tue, 08/26/2014 - 13:36
Just one other thought sparked by Janine's comments. If the lesions are quite small, they may be near the limit of the resolution of the scan, so that even very tiny differences in the scans could make them appear on one scan but not on the next.
Tue, 08/26/2014 - 14:06
Thanks Jim, I'm not up on the details of MRIs but thought as much.
Tue, 08/26/2014 - 14:28
Yes, I agree that it's hard to interpret interpretations of very tiny, subtle changes, particularly if some are resolving. Of course, that would be very "un-cancer-like" without treatment directed at them.
When we see such subtle, very minimal findings, we routinely follow and typically hold off on treatment unless/until we see a convincing, clearer pattern that these are brain metastases. Tiny amounts of hemorrhage from blood vessels or some other vague, uninterpretable tiny little variable could be the cause of such a tiny questionable lesion. We don't need to treat them any sooner than we can reliably identify them as growing brain metastases.
Tue, 08/26/2014 - 15:42
Thank you all for your thorough and quick responses. The reason I'm so hyperfocused on these is mainly because we were told they will prevent my dad from getting on the Pemrbolizumab trial and because I definitely think hearing the word brain disease/tumor/metastasis has been really hard for my dad (understandably). I'm just wondering, I guess more for my own understanding, is it common for known brain tumors in general to shrink on carbo/taxol and further still, is it common for them to shrink long after chemotherapy has stopped? My wife is a veterinarian, and she said that could be conceivable in animals, but she is also always the first one to point out that she is an animal doctor and not a human one.
Tue, 08/26/2014 - 15:48
Janine -- my dad is feeling okay, although weak. The radiation has been extremely effective for his neck pain/nerve irritation. I think he (and the rest of us) are just anxious about getting him back on treatment.
Tue, 08/26/2014 - 21:57
I'm sorry for the ambiguity of the situation. I'm sure that makes it harder.
It's definitely possible for brain metastases to respond to chemotherapy. I wouldn't expect a response after the chemo has been completed, but I'd have to say that it's possible.
Wed, 08/27/2014 - 09:49
Thaks Dr. West. I am trying to view this from the glass half-full perspective in that if they are brain mets, they aren't growing (and possibly even shrinking), which is a good thing.