Brain Metastases: What are the treatment options?
With almost one-third of all cancer patients developing brain metastases, and the instances becoming more common, the availability of a less aggressive and more targeted treatment is welcome news.
Traditionally, the whole brain has been treated, but stereotactic radiosurgery (SRS) means that healthy brain tissue now has less chance of high exposure, and the radiation is delivered more accurately. As well as offering a decreased risk of complications, SRS provides the potential for better quality-of- life for patients after treatment concludes.1,2
What are brain metastases?
A metastatic growth is when cancer cells spread away from the original site they were first identified to another part of the body. In the case of brain metastases, the cancer cells have spread from their primary site to the brain. While this can occur with any type of cancer, the most common sources of brain metastases are melanoma, lung, breast and colorectal cancers1.
Brain metastases cause one or more tumors to form in the brain. As these grow, they can put pressure on the surrounding brain tissue. The result of this pressure can be a change in the patient’s cognitive function and behaviors, such as speech problems and memory loss.
Possible signs and symptoms of brain metastases
If you’re concerned that your primary cancer may have developed into brain metastases, speak to your care team, who can arrange for you to have the necessary checks and tests.
Common symptoms of brain metastases arei:
- Headaches, often combined with nausea and/or vomiting
- Loss of cognitive function such as memory loss and speech problems
- Seizures
- Weakness and/or numbness in the body
Note: this list is not exhaustive and not all patients present with some, or all symptoms listed.
The whole-brain treatment of brain metastases
Whole brain radiation therapy (WBRT) is used to eliminate cancer cells in the brain. As the name suggests, with WBRT the whole brain is treated with radiation, not just the tumors. This means that healthy cells are also impacted by the treatment.
WBRT is often used when surgery is not an option for the patient, but can sometimes be used as an additional treatment following surgery.
WBRT treatments tend to be daily and involve 10-15 sessions spaced over a period of two to three weeks1.
While WBRT has historically been the primary treatment for brain metastases, sometimes followed by stereotactic radiosurgery (SRS), the use of SRS as the primary treatment option is increasing in popularity with physicians. This is due to a more comfortable experience, similar outcomes, and fewer debilitating side effects for patients.1
Side effects of WBRT vary from patient to patient, with some occurring directly after treatment and others sometime later.
Common side effects of WBRT may includeii:
- Fatigue
- Hair loss
- Skin irritation
- Headaches
If you experience any side effects, discuss immediately with your treatment team.
As with all cancer treatment options, there are pros and cons associated with WBRT that you need to consider.
Because WBRT treats the whole brain, undetected cancer cells are also treated, outside of the obvious tumor sites. This means that WBRT may prevent potential tumors from growing.
However, the quality-of-life outcomes for patients following WBRT should be considered. Research2 shows that WBRT can negatively impact memory, fine motor control, and other cognitive abilities.
SRS for brain metastases
SRS differs from WBRT in that it delivers a more targeted dose of radiation to the tumours. Despite affecting less of the brain, there are still some side effects associated with SRS that can include:
- Tiredness
- Scalp reaction
- Patchy hair loss
- Headaches
- Nausea/vomiting
As the post-treatment effects of whole brain radiation therapy have a more obvious impact on the patient’s quality-of-life, SRS may offer some advantages over WBRT. Patients treated with SRS have been shown to suffer fewer side effects following treatment, particularly in cognitive function such as memory loss and speech issues1, making it possible for them to return to normal life and work.
The number of treatments is significantly less, with SRS typically delivered in one to five sessions, meaning less of a time burden on patients.1
Figures indicate that for patients with up to 10 tumors, survival rates and outcomes were the same as those patients who had WBRT.3
While preferred treatment methods and outcomes vary from patient to patient, doctors are increasingly seeking to balance the benefits of treatment with the potential side effects and impact on quality-of-life. Having treatment options that can be tailored to best suit the individual is an important step towards providing better overall patient care and results. Talk to your oncology team about the best options for you.
Disclaimer: Any procedure including treatments involving radiation carry risks, including skin irritation and associated pain. Before proceeding with a referral for treatment, patients should be advised to seek a second opinion from an appropriately qualified health practitioner. As in any medical procedure, patient experiences and outcomes will vary.
References
- Brown PD, et al. J Clin Oncol. 2018;36(5):483-491.
- Amsbaugh MJ, Kim CS. Brain Metastasis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
- Weidle U, Niewohner J, Tiefenthaler, G. Cancer Genomics & Proteomics. 2015;12(4):167-177.
- Tabouret E, et al. Anticancer Research. 2012;32(11):4655-4662.
- Trifiletti DM, Larner JM, Sheehan JP. J Radiosurg SBRT. 2016;4(1):1-3.
- Lunsford LD. J Radiosurg SBRT. 2011;1(2):77-83.
About Sonal Sura, MD
Sonal Sura, MD, MBA has a special interest in breast, skin and GI malignancies. She is Board Certified with the American Board of Radiology in the specialty of Radiation Oncology. Before relocating to Naples, FL to join GenesisCare Oncology, she served as the Director of Radiation Oncology at NYC H+H/Elmhurst, NY and Assistant Professor at the Icahn School of Medicine at Mount Sinai.