Brain mets question

[Susan2]

What is the maximum number of tumors that can be treated with the gamma knife? I am asymptomatic with 7 tumors (largest is 6mm). They really want to do WBR, but I want to be sure that I'm not overlooking something. I've seen 3, 5 and no limit. What are your thoughts?

Thanks. This is scary stuff!

[jojo]

Gamma knife could be done many times as long as the target(s) don't repeat in the same spots. Gamma could target the same position maybe, just MAYBE, twice. But that would put edema at risk. Repeat gamma almost happened in my situation, but instead they decided on a craniotomy. Sure enough, the lesion that regrew in the same place turned out to be malignant. :-(

[pattyz]

Susan,

My second recurrance of brain mets indicated 14 lesions. That was six mos after I had had the first two treated focally.

Since I was also nearly asymptomatic and largest met was 11mm, I was able to have these 14 treated in a series.

I had SRS to four tumors, treating the largest and most dangerously placed.

Then another SRS to an additional four as they grew a bit, several months later.

Finally, was able to have CyberKnife (new facility locally) to treat the final six tumors. This was done in two sessions two days apart, a few months post second SRS.

I am now in a position where my latest (3rd) recurrance of brain mets was determined to be too dangerous to continue focalized rads. Each session of rads DO deliver radiation in a pathway, tho' in small amounts. However, since repeated sessions CROSS paths, it is a cummulative dosage.

I hope that answers your question ) I FOUGHT to proceed this way, but my med onc was supportive, atleast.

best wishes,
pattyz

[al from Canada]

Dear Susan,
My opinion: if you have 7 mets, I would consider the cancer in the brain systemic. The only treatment for that is WBR.

I would look into getting into the allos trial http://www.allos.com/ because the response rate is something like 50% higher. As well, the biggest side effect concern from WBR is collateral damage to the rest of the brain. There are a lot of research results indicating that taking a drug such as arecept or memantine will compensate for that.

I would not take any chances with that number of mets and go for the WBR.

Good luck,
Al

[pattyz]

Al,
sorry to disagree, but my personal experience denies your opinion. As well as a few medical studies done show that there are effective options for brain mets, other than WBR, under certain conditions.

warmest regards,
pattyz

[al from Canada]

I agree with Patty,

You are a true inspiration to all women with brain mets. You never know, as you are well aware, if the decision you make is the right one, but we have to follow our best instincts.

Good luck,
Al

[Susan2]

Thanks for your advice. I met with the radiation oncologist. While he says that the standard of care is WBR, he is willing to consider the gamma knife. He was saying that the latest research tends to indicate that the total volume of mets is more important than the total number of mets. Fortunately, because of the size of the mets, the total volume is fairly low.

For various reasons, I had a CT scan instead of MRI. However, he won't proceed without the MRI. Of course he says that often the MRI shows lesions that don't show on the CT scan. So the number count could go up. A truly scary thought. Based on various postings here, I decided to get a second opinion from Dr. Keith Black at Cedars-Sinai - still waiting to hear back to see if I can get an appointment.