|
 |
We're Ready To Help Call us to schedule an appointment or contact us online
|
|
|
When considering treatment options for a patient with brain metastases, physicians weigh a range of factors -- the number of lesions, the location within the brain, the state of the patient's systemic disease, and his or her overall health. Considered together, these factors determine the optimal treatment for each patient.
Treatments for metastatic brain lesions include surgery, radiation therapy, and sometimes chemotherapy. These therapies may be delivered alone or in combination. Patients also often receive steroids (dexamethasone) to reduce the swelling, or edema, within the brain. Doctors at Memorial Sloan-Kettering use all of these treatments and are also conducting clinical trials to assess new chemotherapy agents for brain metastases.
Surgery
For some patients with one or two brain lesions, surgery may be the best treatment option, as long as the tumors can be reached without causing extensive damage to healthy tissue. Neurosurgeons remove as much of the tumor as possible and at the same time release pressure within the skull caused by the tumor. Improvements in surgical techniques -- particularly image-guided stereotaxy -- have revolutionized brain surgery in recent years.
-
Intra-operative Imaging Suite
To improve the success of brain surgery, Memorial Sloan-Kettering's neurosurgeons perform brain surgery in an intra-operative imaging suite that has a magnetic resonance imaging (MRI) scanner in the operating room. At any point during surgery, the neurosurgeon can rotate the patient into the MRI machine to determine whether the tumor has been removed completely. If any residual tumor is found, surgery can be resumed and the remaining cancerous tissue removed. Being able to reevaluate the patient's tumor with MRI during surgery allows neurosurgeons to operate with increased precision and will reduce the need for and risk of a second operation.
-
Image-Guided Stereotaxy
A very precise method of operating on deep-seated brain structures known as stereotaxy is based on the idea that all points on the brain can be described using a three-dimensional system of coordinates. Using stereotaxy, surgeons can plan operations in advance, and have access to orientation and guidance as the surgery unfolds.
The day before surgery, doctors attach six plastic dots to the patient's scalp and perform an MRI or CT scan of the brain and the tumor. In the operating room, the location of the dots is registered on a computer and matched with the scan. Navigation software and a wand-like viewing device with a light at its tip aid the neurosurgeon in guiding the instruments to the precise location of the tumor.
-
Functional Imaging & Intraoperative Brain Mapping
Functional imaging and intraoperative brain mapping have greatly improved the safety of brain tumor surgery. Functional magnetic resonance imaging (fMRI) uses high-speed MRI to map areas of the brain that are associated with critical functions, such as speech, touch, or movement. The locations of these areas in the brain can vary from one person to the next. fMRI is used for those patients whose metastases are adjacent to tissue responsible for one of these functions, so that the surgeon can plan the surgery to avoid disrupting these important areas and preserve the patient's quality of life.
Surgeons at Memorial Sloan-Kettering now operate on about half of brain cancer patients while they are awake. During the operation, they probe the area around the tumor using small electrodes, while asking the patient to talk, count, look at pictures, and perform other basic tasks. This process helps them locate the "eloquent" regions in the brain, which govern speech, the senses, and movement. Surgeons can then avoid these sensitive tissues while removing as much of the tumor as possible.
-
Neuroendoscopy
Some procedures are now performed using neuroendoscopy, in which the neurosurgeon works through a small opening in the skull using a thin tube with a powerful lens, a powerful light, and a high-resolution video camera to see into the skull and brain. Advantages of this minimally invasive neurosurgical procedure include a small incision site, an enhanced ability to perform microsurgical procedures, and potentially less trauma to healthy tissue.
Radiation Therapy
New methods of radiation therapy -- many of which have been pioneered at Memorial Sloan-Kettering -- allow doctors to raise the dose of radiation delivered to a metastatic brain tumor, enhancing precision and minimizes the amount of radiation that reaches healthy tissue.
These technological advances rely on Memorial Sloan-Kettering's team approach to cancer care, involving specialists in radiation oncology, neurosurgery, medical physics, and neurology, whose combined expertise is critical to ensure that the treatment is delivered most effectively and with a minimum of damage to healthy brain tissue.
-
Stereotactic Radiation Therapy
Memorial Sloan-Kettering radiation oncologists use a micro-multileaf collimator system for radiosurgery and also for more conventional radiation treatments. In stereotactic radiation therapy, the radiation beam is conformal (meaning the instrument looks at the tumor in three dimensions and conforms the radiation beam to its outlines) and intensity modulated (meaning the beam moves so that it spreads the radiation dose, and all areas get the same dose). The instrument is very precise and fashions the radiation dose much closer to tumor boundaries than other instruments used for this purpose, such as the gamma knife. This spares the surrounding brain any significant radiation dose.
Stereotactic radiosurgery may be used to treat most patients with three or fewer smaller brain lesions. Candidates for stereotactic radiosurgery include those whose lesions are not surgically accessible, who cannot tolerate anesthesia, or whose systemic disease is too advanced for neurosurgery.
-
Whole-Brain Radiation Therapy
When patients have large lesions deep in the brain or many lesions throughout the brain, whole-brain radiation therapy is the best treatment option. The treatments are administered over a course of weeks to minimize side effects.
Investigators here are also assessing the effectiveness of stereotactic radiosurgery following surgical removal of metastases, to see if this combination of treatments is a more effective way to prevent metastases from recurring.
Find a Clinical Trial Find out about new research studies for brain metastases
|
|
|
Chemotherapy
Because most metastatic brain tumors are unresponsive to chemotherapy, chemotherapy is rarely part of a treatment regimen for these patients. However, there is increasing recognition that many standard chemotherapeutic agents work against brain metastases in some patients. In addition, new chemotherapeutic agents, such as temozolomide, are effective in some patients with brain metastases. Temozolomide has known effectiveness against some forms of primary brain tumors. This oral chemotherapeutic agent is able to cross the blood-brain barrier -- the protective shield formed by special cells lining the capillaries in the brain that prevents many cancer drugs from penetrating to brain cells. However, all brain metastases have an abnormal blood brain barrier that allows at least partial penetration of drugs into the tumor even if the agent cannot reach the healthy brain tissue. This is the reason an increasing number of drugs are recognized as working against brain metastases.
Memorial Sloan-Kettering physicians are currently testing new agents specifically targeting brain metastases in clinical trials.
Last Updated: Apr. 9, 2007
|
|
|
|
