B-Aware Program Educates Cancer Patients about Brain Metastasis
Tuesday, March 15, 2011
For many years oncologists considered brain metastasis as a uniformly fatal condition and treatments were limited to palliative brain radiation.
Photo: Gene Barnett, M.D., M.B.A., F.A.C.S.
Over the last two decades, however, approaches that are more aggressive and accurate have been developed possibly leading to a local cure or a sustained control of the disease in some patients. Yet, cancer patients with system cancers are often poorly informed about the risks of developing brain metastasis, its early warning signs and modern therapeutic options available beyond the traditional treatment of whole brain radiation. The B-Aware (where ‘B’ is for brain) Program has been developed in collaboration with the Northern Ohio American Cancer Society to educate cancer patients about the risks, symptoms and treatments for brain metastases.
Understanding the Risks. An estimated 140,000 to 170,000 patients with common system cancers are diagnosed with brain metastasis each year in the United States, particularly patients with breast, lung and kidney cancers, and melanoma.
Understanding the Symptoms. In addition to the risks, cancer patients also should recognize the common symptoms that may indicate brain metastasis. Many of the symptoms are similar to those of an acute stroke. However, the symptoms for brain metastasis typically manifest gradually as opposed to suddenly as in a stroke. Common symptoms include problems with vision, balance, speech, strength, or memory, numbness, progressive headache or seizures. Patients need to be aware that when they experience the onset of any of these symptoms, particularly when the symptoms begin to become more frequent, prolonged or become worse, they should contact their oncologist immediately. Aggressive therapies may improve outcomes when brain metastasis is diagnosed in its early stages.
Aggressive treatment works. Traditional treatments such as whole brain radiation and glucocorticoids still play important roles in the treatment of brain metastasis. For many patients, however, whole brain radiation is inadequate to achieve sustained control and quality. In fact, it may be best reserved for later use as opposed to being used as a first line of treatment in some cases.
Alternatively, research has shown that aggressive treatments such as minimal access surgery and radiosurgery can help an appreciable number of patients to survive five years, and in some cases, 10 years or more.
Neurosurgeons commonly utilize aggressive therapies such as minimal access procedures to extract metastatic tumors. For patients with new or recurrent metastatic tumors following radiotherapy, surgery in conjunction with the placement of carmustine wafers in the tumor cavity or radiosurgery to the tumor cavity may preclude local recurrence.
Gamma Knife cranial radiosurgery in particular allows for state-of-the-art stereotactic radiosurgery to treat metastatic tumors. Lesions are typically small (<3 cm at presentation) and spherical, which displace rather than infiltrate the brain. Results from radiosurgery appear comparable to those achieved by surgery with radiotherapy, and allow for effective treatment even for surgically inaccessible secondary brain tumors.
A recent multi-centered randomized trial showed that radiosurgery in addition to whole-brain radiotherapy led to improved survival or enhanced quality of life for patients with one or more metastatic brain tumors, respectively. In addition, radiosurgery may reduce the chance of leptomeningeal spread compared to surgery for certain types of tumors.
Other treatment options. In some cases, chemotherapy may be a treatment option. For example, patients who have systemic breast cancer and brain metastases with lesions that are estrogen-receptor positive may respond to high doses of Tamoxifen, which can compensate for the medication’s limited penetration to the brain. What’s more, temozolomide — an orally administered methylating agent — effectively penetrates the brain and may be considered for selected patients.
Often times, by applying a combination of these aggressive therapies, we are able to control brain metastasis for an extended period of time for patients and improve their overall quality of life.
Gene Barnett, M.D., M.B.A., F.A.C.S., is the Director of The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center at Cleveland Clinic. His specialty interests include neurosurgical management of adult benign and malignant tumors of the brain and spinal cord, trigeminal neuralgia, Gamma Knife cranial radiosurgery, image-guided surgery, laser interstitial thermal therapy, brain mapping, awake surgery, intraoperative MRI and clinical trials. The B-AwareSM Program was created by Dr. Barnett.
MD News March/April 2011, Cleveland/Akron/Canton