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Written by: DR. Warren goldMAN

What are my options if my cancer travels to my brain?

Of the nearly 2 million patients that are diagnosed with cancer each year in the United States, approximately 1 in 3 will experience brain metastasis (mets), or spread through the blood stream, to settle and grow in the brain. If these tumors are small, even if there are a numbers of mets, they may be asymptomatic and found only with early scanning using contrast-enhanced MRIs. Early though not necessarily urgent treatment, along with regularly scheduled MRI scanning, is vital to effectively treating these potential harmful brain tumors and providing the best chances of preservation of normal brain function.

Unique to the brain is the presence of the “blood brain barrier” (BBB), a protective mechanism that prevents the passage of harmful substances from getting into delicate brain tissue. Unfortunately, chemotherapy, as well as most immunotherapy, is treated as a toxin by this barrier. As a result, while these treatments are the mainstays for the primary cancer, they are uniformly ineffective in treating the same tumor once it spreads to the brain. As a result, radiation, which penetrates the BBB, is the definitive treatment for brain disease.

Not infrequently, signs of spread to the brain are ignored or not appreciated, and tumors may grow to a larger size and pose an immediate threat to neurological function or, in extreme cases, coma and death. These cases require urgent surgery to remove these lesions (tumors), which often successfully allows the opportunity to restore function and proceed with radiation. The options at this point depend on the size and number of tumors and the overall condition of the patient. The first choice should be focused-beam radiosurgery, a radiation technique that precisely targets and delivers high dose, cancer-killing beams of ionizing radiation in a single treatment session. Candidates for this treatment harbor smaller, well-defined tumors that are most susceptible to single fraction radiation, which are most common. A high number of small tumors or a number of large tumors may be more suitable to whole brain radiation, whereby the patient will have no choice but to accept the adverse side effects that are avoided by precision delivery technologies.