Brain Mets - what did you do?

[supermehra]

Single brain met discovered 9 months ago 3 cms in size - came up suddenly as previous 9 month old MRI was clear.

Treated with Gamma, probably wrong decesion as the size was too big... but they sounded so convincing at the hospital. Was fine for 3 months, then started to develop a lot of edema & seziures, uncontrolled despite 16mg of decsamethasone

The met was 6 years after primary and 1 year after initial metastases to sternum. Treated with taxol, AC, herceptin prior. Her/neu 3+ er/pr-

Finally had the surgical excision today! Now waiting to start xeloda+tykerb. Will post results. (those who are wondering, the patient is my mother)

My discussions with doctors have highlighted:

1. Gamma is good for very small lesions <1cms; anything larger, avoid gamma if surgery is possible.

2. Tykerb cannot "de-mass" large tumours. I.e. they don't know if it will act against existing tumours. It is to block disease progression primarily. The GSK 329 patient trial suggests that mean avg time to progression stretches to 8.5 months.

3. Best choice for easily operable tumours in my humble opinion is quality surgery. Gamma can be saved for radiating the tumour bed in the future. Also, if gamma is avoided, WBR becomes a little more palatable to the brain... this is a simplistic view that the brain would be better off with least radiontion.

4. Gamma also tends to leave (in our case) post radiation necrosis; this may or may not result in edema leading to other complications unless controlled by steroids. Of course, this depends largely on the dosage of radiation.

No other distance metastases detected... hoping for the best... lot of hope of Tykerb+Xeloda combo.