Radiation Therapy For Metastatic Brain Tumors
Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.
These painless treatments involve passing beams of radiation through the brain, which can treat cancers in areas that are difficult to reach through surgery. Procedures may include any one or a combination of the following:
- External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
- Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
- Stereotactic radiosurgery directs a high dose of radiation targeted to the specific shape of the tumor, sparing surrounding healthy tissue from unnecessary radiation exposure.
- Proton therapy uses protons to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.
Because radiation therapy has been so successful in treating brain metastases and because many live long lives after treatment studies are now looking at how to manage the long-term effects of treatment.
D Diagnosis Of Brain Metastases
Brain metastases were diagnosed 0 to 37 years after the initial diagnosis of thyroid cancer, with a mean Â± SD of 10.6 Â± 10.4 years. The mean age at diagnosis of brain metastases was 57.4 Â± 11.2 years. The lesions were diagnosed by MRI for 12 patients, by CT for 6 patients, and by positron emission tomography-CT for 4 patients. For 2 patients no radiologic report was available, but the oncologist communicated the diagnosis of brain metastasis.
How Do You Decide Which Metastatic Brain Cancer Treatment Is Right For You
Your neurosurgeon will discuss the most appropriate treatment approach with you by considering these and other factors:
- The type of primary cancer, your response to treatment and current status
- The location and number of metastatic tumors within the brain or spine
- Your general health and preferences regarding potential treatment options
- Your current symptoms
Along with benefits, doctors also consider the potential risks and side effects of any treatment. Many patients are worried about the effects of radiation. Others hesitate about the idea of surgery. Tell your doctor about your concerns they are important to consider.
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F Modalities Of Treatment Of Brain Metastases
Patients were treated with combinations of surgery, stereotactic radiosurgery and/or whole-brain radiotherapy . Of 24 patients, 10 had surgery, 8 had SRS, and 10 had WBRT . Patients undergoing surgery had a median survival time of 27.3 months, compared with 6.8 months for those who did not undergo surgery. This difference was not statistically significant . Patients who received SRS had a median survival time of 52.5 months in comparison with 6.7 months for those who did not receive SRS. Again, the difference was not statistically significant . For WBRT, no difference was noted in the survival of patients receiving or not receiving this therapy .
Kaplan-Meier curves of death from date of brain metastases by neurosurgery , SRS , and WBRT .
Twelve patients were treated with a tyrosine kinase inhibitor . Of these patients, 8 were treated with a single agent and 4 patients received two or three agents in sequence . Patients who were treated with TKIs had a median survival time of 27.2 months in comparison with 4.7 months for those who were not treated with a TKI. This difference was statistically significant . The use of TKIs reduced the odds of death by approximately 73%. The log-rank test confirmed that the Kaplan-Meier curves were statistically different.
What Questions Should I Ask My Doctor
Learning about your condition can empower you to make informed decisions. Some people only want to know the basics, while other people prefer to know every detail about their prognosis. Here are some questions you may want to ask your healthcare provider:
- Are there things I can do to improve my prognosis?
- What are my treatment options?
- Are there clinical trial options that might be appropriate for me?
- Will palliative care continue even if I stop cancer treatments?
- How often will I need to schedule follow-up appointments?
- Do I need to consider hospice care?
- Should I choose a person to make medical decisions for me when Im unable to make them for myself?
- What legal documents should I have in place?
- What resources are available to help me cope with my prognosis?
A note from Cleveland Clinic
A metastatic cancer diagnosis is one of the scariest things you may ever encounter. If you or a family member has been diagnosed with advanced cancer, youre probably feeling a lot of complicated emotions. While most metastatic cancers arent curable, there are treatments that can ease your symptoms and prolong your life. Ask your healthcare provider for resources and consider joining a local support group. Talking with other people who are going through the same thing can be healing during this emotionally difficult time.
Last reviewed by a Cleveland Clinic medical professional on 12/20/2021.
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Patients Without Initial Evidence Of Distant Metastases
Fourteen of the 47 patients had no evidence of distant metastases at initial preoperative or postoperative staging. The median primary tumor size was 2.5 cm, significantly smaller than 4.5 cm for the group of 33 with initial distant metastases . The median interval between the diagnosis of thyroid carcinoma to diagnosis of brain metastases was 6.5 yr, which was significantly longer than the 0.9 yr for those with any initial distant metastases . Disease-specific mortality was 71%. The median disease-specific survival after diagnosis of brain metastases was 4.7 months for patients without any initially diagnosed distant metastases, which did not differ from those with brain metastases who had distant metastases in any site at initial disease staging .
What Can I Expect If I Have Metastatic Cancer
Your healthcare provider will work closely with you. Theyll monitor your symptoms and find treatments to ease them. Youll probably have many medical visits and will need to make important decisions regarding your overall health.
Is metastatic cancer curable?
In most cases, metastatic cancer is not curable. However, treatment can slow growth and ease many of the associated symptoms. Its possible to live for several years with some types of cancer, even after it has metastasized. Some types of metastatic cancer are potentially curable, including melanoma and colon cancer.
What is the metastatic cancer survival rate?
The five-year survival rate of metastatic cancer depends on the type of cancer you have. For example, the five-year survival rate for metastatic lung cancer is 7%. This means that 7% of people diagnosed with metastatic lung cancer are still alive five years later. Meanwhile, the five-year survival rate of metastatic breast cancer is 28% for women and 22% for men.
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Metastatic Brain Tumor Surgery
Surgery provides fast relief of mass effect pressure inside the skull resulting from a growing metastatic tumor and swelling of the brain. Some patients may find improvement of symptoms as early as within hours of surgery if mass effect is what is causing your symptoms.
The goal of surgery is to minimize the amount of space the tumor takes up by debulking, which means removing as much of the tumor as possible while maintaining neurological function.
In general, doctors recommend surgery for metastatic brain cancer when:
- There is a clear link between the symptoms and the tumors location.
- The primary cancer is treatable and under control.
- The tumor can be safely removed.
The most common type of surgery to remove metastatic brain tumors is called a craniotomy, which can be performed through a variety of approaches, including the keyhole craniotomy.
Learn more about brain tumor surgery and recovery.
Brain Metastases In Patients With Thyroid Cancer
Background:Objetive:Material and Method:Results:
Tuttle RM, Leboeuf R, Martorella AJ. Papillary thyroid cancer: monitoring and therapy. Endocrinol Metab Clin North Am 2007 Sep 36:753-78, vii. PubMed PMID: 17673127.
Hundahl SA, Cady B, Cunningham MP, Mazzaferri E, McKee RF, Rosai J, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer 2000 89:202-17. PubMed PMID: 10897019.
Baudin E, Schlumberger M. New therapeutic approaches for metastatic thyroid carcinoma. Lancet Oncol. 2007 8:148-56. PubMed PMID: 17267329.
Pacini F, Schlumberger M, Dralle H, Elisei R, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol/European Federation of Endocrine Societies 2006 154:787-803. PubMed PMID: 16728537.
Tubiana M, Schlumberger M, Rougier P, Laplanche A, et al. Long-term results and prognostic factors in patients with differentiated thyroid carcinoma. Cancer 1985 Feb 15 55:794-804. PubMed PMID: 3967174.
Chiu AC, Delpassand ES, Sherman SI. Prognosis and treatment of brain metastases in thyroid carcinoma. J Clin Endocrinol Metab. 1997 Nov 82:3637-42. PubMed PMID: 9360519.
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What Are The Most Common Sites Of Metastatic Cancer
The most common sites for cancers to metastasize include the lungs, liver, bones and brain. Other places include the adrenal gland, lymph nodes, skin and other organs.
Sometimes, a metastasis will be found without a known primary cancer . In this situation, your healthcare provider will search extensively for the primary cancer source. If none can be found, its called cancer of unknown primary .
What Happens When Cancer Spreads To The Brain
Cancer cells can break away from the primary tumor and travel to the brain, usually through the bloodstream. They commonly go to the part of the brain called the cerebral hemispheres or to the cerebellum, where they form a mass.
Some metastatic brain tumors appear many years after the primary cancer. Others metastasize so quickly that they are identified before the primary cancer.
When the cancer cells reach the brain and form a tumor, it may lead to a variety of symptoms that can be shared by nonmetastatic brain tumors as well.
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How Are Metastatic Brain Tumors Treated
Treating a brain tumor is usually only one step in treating metastatic cancer. At Yale Medicine, treatment is carefully coordinated among the neurosurgery, radiation oncology, and medical oncology teams.
Treatment for brain metastases usually involves radiation and surgery, since chemotherapy has limited ability to penetrate the brain. Patients may also be given corticosteroids to reduce swelling, as well as anti-seizure medications.
Patients whose brain scans reveal only a few metastases can be considered for a targeted radiation treatment called radiosurgery. At Yale Medicine, this treatment is delivered using a machine known as the Gamma Knife. If this procedure deemed appropriate, imaging required for treatment, treatment planning, and radiation delivery can all be done in one day.
For those with larger or more widespread brain tumors, Yale Medicine also offers the more comprehensive treatment options, including:
- Hippocampal sparing whole brain radiation therapy with memantine
- Surgical resection or laser ablationguided by MRI in the operating room
- Microsurgical resection of tumor
Chemotherapy For Metastatic Brain Tumors
Because traditional chemotherapy cannot cross the blood-brain barrier, newer treatments called targeted therapy are used as the primary type of chemotherapy for treating metastatic brain tumors.
These drugs identify and attack cancer cells with minimal harm to normal cells while preventing the growth and spread of cancer cells. Targeted therapy can be administered after surgery or in conjunction with radiation therapy to destroy remaining cancer cells.
Targeted therapies used to treat metastatic brain tumors include:
- Trastuzumab for breast cancer that has spread to the brain
- Erlotinib for the most common type of lung cancer that has spread to the brain
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What You Need To Know
- Metastatic brain cancer is caused by cancer cells spreading to the brain from a different part of the body.
- The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin , colon, kidney and thyroid gland.
- Metastatic brain tumors are five times more common than primary brain tumors .
- Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in different areas of the brain.
What Are Brain Metastases
Brain metastases are when cancer cells from your primary site spread to the brain. Brain metastases, often called “brain mets,” are more common than primary brain tumors . Studies suggest brain metastases happen in about 10%-30% of patients with cancer.
Brain mets are different from a primary brain tumor . For example, lung cancer starts in the lung cells. These tumor cells can break off from the original mass in the lung. The lung cancer cells travel through the bloodstream or lymph system to other parts of the body, like the brain. This spreading of the tumor is known as “metastasis. When lung cancer metastasizes to the brain, these mets are made of lung cancer cells.
You can have many brain metastases at the same time in different parts of the brain. Any cancer can spread to the brain. Brain mets are most common in lung cancer. Other cancers that often metastasize to the brain are melanoma, breast cancer, colon cancer, and renal cell cancer.
There has been a rise in the number of brain metastases in recent years. This could be because we have better tools to diagnose brain metastases. People are living longer with metastatic disease due to advances in cancer treatments.
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Signs Symptoms And Diagnosis
Common signs and symptoms of brain metastases are:
- Cognitive changes .
- Behavior/mood changes.
- Feeling unsteady, losing coordination or balance .
- Vision changes.
If you are having any of these symptoms, contact your care team right away.
If your provider thinks you may have brain mets, they will order imaging studies to look at your brain. You may need a biopsy if the primary cancer type is unknown or if there has been a long period of time between treatment for the initial primary cancer and your new symptoms.
What Are The Risk Factors For Metastatic Brain Tumors
Doctors do not yet know why some cancers spread to the brain and others do not. What is known, however, is that brain metastases can occur in any long-term cancer survivor.
In addition, certain cancers, such as melanoma, or some subsets of other cancerssuch as EGFR-mutant lung cancer and HER2-positive breast canceralso seem to be more likely to spread to the brain.
Patients with these cancer types should undergo brain scans on a regular basis.
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How Do I Take Care Of Myself
Being diagnosed with metastatic cancer comes with many challenges. These challenges vary from person to person, but you might:
- Feel sad, angry or hopeless.
- Worry that treatment wont work and that your cancer will get worse quickly.
- Get tired of going to so many appointments and making so many important decisions.
- Need help with daily routines.
- Feel frustrated about the cost of your treatment.
Talking with a counselor or social worker can help you cope with these complicated emotions. Managing stress is also an important aspect of self-care. Practice meditation, mindfulness or find other ways to reduce stress and anxiety.
Metastatic Brain Cancer Treatment
It is important to know that metastatic brain tumors are often treatable, and can be well-controlled. Generally, the faster you start treatment, the better the chances of killing or controlling the disease.
The treatment options for brain metastases may include:
- Clinical trials
In many cases, surgery or radiation therapy can improve or entirely get rid of symptoms. Read more about brain tumor treatment.
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When Does Metastatic Thyroid Cancer Show Symptoms
Metastatic thyroid cancer, also known as stage 4 thyroid cancer, refers to cancer that has spread from the thyroid gland to distant areas of the body. This is the most advanced stage of thyroid cancer. At this late stage, many symptoms are likely to be present. In fact, symptoms typically appear at an earlier stage and can often be detected before the thyroid cancer has metastasized.
What Are The Symptoms Of Metastatic Cancer
Some people will have minimal or no symptoms of metastatic cancer. If symptoms are present, theyre based on the location of the metastasis.
Bone metastasis may or may not cause pain. The first sign of bone metastasis is bone breakage after a minor injury or no injury. Severe back pain accompanied by leg numbness or difficulty with bowel or bladder control must be evaluated immediately.
If a tumor has metastasized to the brain, symptoms may include headache, dizziness, visual problems, speech problems, nausea, difficulty walking or confusion.
Cancer symptoms of lung metastasis are usually very vague. This is because they can be similar to symptoms of other health conditions. Warning signs may include a cough , coughing up blood, chest pain or shortness of breath.
Liver metastasis can cause pain, weight loss, nausea, loss of appetite, abdominal fluid or jaundice .
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A Pathology Of The Thyroid Tumor And Extracranial Metastases
Fifteen patients had papillary thyroid cancer . Of these, 10 patients had classical variant and 5 had follicular variant of PTC, either pure or with areas of poor differentiation or tall cell features . Seven patients had follicular thyroid cancer , of whom 2 had areas of poor differentiation and 2 patients had HÃ¼rthle cell features. One patient had poorly differentiated thyroid cancer, and 1 patient had no report from the original tumor but had confirmed brain metastases from differentiated thyroid cancer. In patients with brain metastases, individuals with PTC had a median survival time of 27.3 months compared with 4.7 months for patients with FTC and 1.06 months for the patient with poorly differentiated thyroid cancer. This difference was statistically significant .
For patients in whom the original thyroidectomy pathology report was available, the mean size of the tumors was 3.2 Â± 2.0 cm. We could not classify the initial stage of all patients because nine patients had thyroid surgery and initial follow-up of thyroid cancer at other institutions, and the histology of the original tumor was not available. TNM classification of patients whose original pathology report was available is presented in Table 1.
All but one patient had extracranial metastatic disease, notably in the lungs and bones . The only patient who had no report of other metastatic sites had an irregular follow-up.