61 it old male, dx Aug 2012 stage IV adeno with one brain met (Cyberknife), and one in hip. EGFR+, Tarceva for over two years, no active disease outside brain, but six new brain mets in last six months, three more Cyberknife sessions, now coming with greater frequency, and two previously treated with Cyberknife now regrowing.
Recommendation is WBRT. In good health otherwise.
Question #1: Should I pursue Hippocampal sparing? I use my brain a lot in my profession (clergy) and my life. Is Hippocampal sparing ready for prime time? Should I worry that if a met develops later in the untreated margin near hippocampus, that even after a Cyberknife treatment it might grow back (given my history of such) and WBRT would not be there as a backup? Or should I worry more about cognitive and memory decline?
They don't use this technique where I am currently, but I can get to where they do if it's worthwhile.
Question #2: Should Tarceva be stopped before and during WBRT? Two weeks plus is a long time, especially with the possibility of a flare up. Is there a danger or a downside in continuing Tarceva during WBRT? Is there even a possible benefit?
I realize I'm asking questions for which there may not be clear unequivocal answers, but I do need to make these decisions now.
Any information and recommendations would be greatly appreciated, as I need to have this done very soon.
Thank you for your help.