If you have been recently diagnosed with a metastatic brain tumor, one of the next steps to take is to decide upon a brain metastases treatment. Your healthcare provider will make recommendations based upon the location, size and nature of your tumor, but you will ultimately be asked to consent to all treatment. To do so, it helps to be as informed as possible about both your condition and the treatment options you have available.
Because your condition is a metastatic tumor, that means that it grew from cells at another site in your body and spread to your brain. Treatments for this type of brain tumor are typically even more effective than for primary brain tumors, with higher success rates and less need for retreatment.
Brain metastases treatment typically falls into two categories: radiation and surgery. Chemotherapy tends to be less effective in treating all forms of brain cancers, because the body protects the brain and does not allow drugs to cross what is known as the blood-brain barrier. The result is that the medicine can never reach the tumor site, so chemotherapy is not typically an option.
Some patients will be better candidates for one type of surgery over another, while others will require multiple treatment modalities. Every patient is different, so your oncology specialist will recommend what they feel is the best plan for you.
Stereotactic Radiosurgery/Gamma Knife Radiosurgery
Despite being called “surgery,” stereotactic radiosurgery is actually another radiation therapy used to treat brain metastases. The name refers to the precision involved, which makes it similar to surgery in nature, but there are no incisions required.
During stereotactic radiosurgery procedures, the neurosurgeon uses a very focused beam of radiation from different angles to treat the tumor. This minimally invasive technique is favorable for many patients because, unlike whole brain radiation, it only treats tumor cells and spares healthy brain tissue and often only requires a single therapy session.
Whole Brain Radiation
Whole brain radiation is a brain metastases treatment that delivers low doses of X-ray radiation to the entire brain during multiple different sessions. This treatment has been the standard of care for brain tumors in the past and may still be the preferred option for patients who are not candidates for other radiation therapies or surgery.
Some patients will require surgery prior to undergoing radiation therapy. This typically happens if your tumor is relatively large or surgically accessible. Surgery typically involves a craniotomy, where the surgeon removes a small section of skull to better access the tumor. Then they will cut out as much of the tumor as possible. If the origin of your metastases is unknown, they may send a section of the tumor to a pathologist to look at it under a microscope.
Even if your surgeon can remove most or all of your tumor, you will still need to undergo some form of radiation therapy. This is because if any cells remain, they have the potential to regrow and form a new tumor, requiring retreatment.
Because your condition and treatment plan are specific to you, your recovery is a very individual thing. Factors that may impact it include other pre-existing health conditions, age, tumor size and location, and treatment modalities.
It is worth noting that because of the minimally invasive nature and precision of Gamma Knife and stereotactic radiosurgery, these side effects are uncommon. Recovery time is also typically shorter, because treatment is usually limited to a single session, rather than multiple sessions.
In general, following whole brain radiation, you can expect to experience side effects common to radiation therapy, including hair loss, skin irritation, nausea, vomiting and headaches. Because whole brain radiation affects healthy cells along with tumor cells, there is also a chance of temporary neurological effects, including fatigue, memory loss and difficulty with speech.
For traditional surgery, recovery time will depend upon your circumstances, but you can expect to spend at least a few days in the hospital while your health care team monitors your recovery. In the long term, you may experience neurological deficits as listed above, but they are typically temporary. Again, because tumors have a 50 percent chance of recurring without follow-up radiation therapy, you will likely undergo further treatment when your oncology team decides you are ready.
Choosing a Brain Metastases Treatment
Every patient is different, and you are no exception. The brain metastases treatment that is right for you depends upon your age, health, tumor location, size and personal needs. Chances are if your tumor is small, your diagnosis is already known, and/or you cannot undergo traditional surgery, radiation therapy will be recommended. However, if your tumor is large or requires biopsy, your doctor may suggest surgical removal.
Regardless of your individual treatment plan, you now understand a little more about your brain metastases treatment options. If you still have questions, be sure to ask your physician or surgeon. Self-education is the key to having confidence in your treatment and will allow you to consent to procedures with a better understanding of your condition, treatment and recovery.