[gdpawel]

Joyce

The Patchell studies have never shown any value (improving overall survial) of whole brain radiation. The morbidity associated with whole brain radiation does not justify its use. Particularly with today's small molecule intervention.

The idea that systemic therapies can be as effective as PCI, WBR or even stereotactic radiosurgy has been looked upon for a number of years now, with agents like Temodar and EGFR inhibitors against brain metastases.

Accumulating evidence suggests that systemic chemotherapy may play an important role. There have been clinical observations of frequent brain metastasis responses with systemic chemotherapy.

With a brain metastasis indicated or not, small molecule intervention can be beneficial by dissolving through the capillary cell membranes and absorbed into the brain. Systemic brain chemotherapy can also treat coexistent systemic disease.

A drug like Temodar is small molecule. Empirically, it has been shown to cross the BBB to affect cell death in circulating tumor cells. Exciting results have come from studies of multitargeted tyrosine kinase inhibitors, small molecules that act on multiple receptors in the cancerous cells, like Tykerb and Sutent.

Iressa and Tarceva have been shown to cross the blood-brain barrier and some patients may get a long-lived remission with these drugs. High-dose tamoxifen can be given as a potentiator and an anti-angiogenic effect.

But if one is already getting whole brain radiation, perhaps Avastin can be given in low doses before radiation or intermittently afterword to reduce VEGF levels and protect the brain from abnormally high levels of the protein.

I never thought whole brain radiation was necessary or even effective when my wife received it and after many years of researching it, I still don't. There are a lot of better alternatives.