pattyz

Kim, you asked:
<<<I wonder what the clinical indications are to doing focalized rads vs whole brain and what are the indications to stop treating?>>>

There are some cases of single brain mets and cases of several with recurrance of a few more. So, IMO only, it makes sense to go straight to focalized rads (mayber with regular surgery if possible), skipping WBR.

The 'gold standard' is surgery where possible plus WBR. But more oncs are going to focalized rads to 'clean up' area. Where surgery is not possilble, WBR is still the norm first recommeded.

There have been many many studies done using combinations of these tx's. The least successful of all tx's is WBR alone. Doesn't mean it has no successes though.

Clinically, if any brain met is larger than 3cm, focalized rads are not possible. So, surgery if accessable plus WBR. Or WBR alone.

Clinically, if mets are very symptomatic, a high dose of Decadron is started immediately. Followed by one or another type tx dependant on size of mets as I said.

Indications to stop treatment: Where all 'regular' treatments have been tried and failed, sometimes a second course of lower dose WBR is done. Or, if/where available some could go into a trial. Or, in my own case, I'm trying a chemo combination. Treatment stops when there is permanent disabling brain damage or severe progression of other mets indicate death is near or likely soon.

There are more gals who die from progression of their other mets first than from their brain mets progression alone. There is not alot of good info on people like me with brain mets alone...
That is changing though with the advent of Herceptin.

whew!! hope I didn't give you more info than you wanted, lol!!
hugs,
patty