[agness]

That is what happened to me but, in the case of surgical resection in the posterior fossa area of the skull (low-back of skull, where the cerebellum resides) is actually higher due to restricted flow dynamics from what I have been able to glean.

I would argue that while brain radiation is not necessary but either pre-operative treatment of the tumor area to damage the cancer before surgery (something that is in studies now), adjuvant treatment with IT Herceptin (ommaya ports aren't fun but unlike WBR it is reversible and targeted, adjuvant therapy to prevent LM already happens for melanoma, leukemia and lymphoma in the CNS), and partial brain irradiation instead of WBR are more appropriate than nuking someone's brain with WBR. Why would you irradiate someone with a large tumor's entire brain when it is local disease spread that is an issue? Also, note that they are unable to diagnose LM until months into the progression which further limits the options while promoting disease spread.

The really sad and frustrating part is that this is going to keep on happening because it takes years for doctors to change their practices. They won't learn from anything I have tried for better or worse because only patients are able to read about my profession details, clinically I don't exist.

The standard for monitoring of central nervous system disease need to change to reflect the realities for patients at high risk -- HER2 and TNBC with nodal involvement as the first site of mets for the first two years and I'm sure other criteria could be set for those with systemic disease as well. We shouldn't be forced into a place where craniotomies to remove large tumors is the standard.