Nervious about brain met treatment decisions
I'm a long time viewer and infrequent poster to this group, but am now at my wits end regarding my wifes treatment options for brain mets. This past weekend severe headaches led to the discovery of brain mets. The head CT scan shows 4 mets with the largest being 1.5cm, two showed signs of bleeding. A follow up MRI showed an additional 6 very small mets. This is to go along with liver and lung mets that are currently being held in check and a breast tumor that is quite large.
She was originally diagnosed in dec-06, breast surgery was post poned to treat the other sites, the liver and lung. The surgery(right side mastectomy) was scheduled for 11/27, but the discovery of brain mets may alter that date if we go with the recomendations of the ONC and radiation folks. I'm not sure if that is the correct decision.
The recommendation is WBR(whole brain radiation), we are told that this is the best approach due to the number of mets and it may also target mets that are seeding themselves and don't show up on the MRI. Taking this approach would mean postponing the mastectomy and being off chemo for at least 4 weeks or longer if the surgury is squeezed in. I'm not sure this is a good choice as we have already waited almost 1 year for breast surgery.
I would like to explore gamma knife type of treatment on the 4 larger brain mets and keep the breast surgery on schedule. The breast tumor is huge and has to go. My wife is frantic to start some sort of treatment immediately, but she has blind faith in her Dr's who suggest WBR. I think going with WBR and putting everything else on hold for 4-6 is a decision that we shouldn't take lightly. We have an appt for a second opinion on thursday at NEMC in boston, a facility that offers the gamma knife.
How does one make such a decision, it almosts seems like a coin toss.
If we wanted to go the gamma knife route how do you convince your Dr's? I've seem others on this site with more mets than my wife that went the gamma knife route with great sucess.
In my mind we have two options.
(A).
WBR for 3 weeks.
No chemo for breast liver and lung for 4-5 weeks. Her ONC says possibly forever as she was very pessimistic after the discovery of brain mets. When my wife pressed her for a date, she gave her 3-6 months.
No surgery to remove large breast mass. This will have to be postponed during WBR.
If surgery is rescheduled after WBR this will further delay chemo to treat other areas.
(B)
Target 4 large brain mets with gamma knife type technology.
Keep breast surgery on schedule. That tumor has to go, it didn't seem to respond to taxol while liver and lung did.
Get back on chemo quicker. Her next drug was going to be xeloda, i've seen stories that this may cross the brain barrier.
Monitor brain mets, leave WBR on the table as a future option.
Her Dr's plan is option A, option B is my plan, but don't even know if it's really an option. I don't know how to convince her Dr's that this is an option, they should know better than I. My wife has blind faith in her Dr's, she doesn't go online at all, I wish she did.
Any opinions?
Thanks
John Cummings
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