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What are the risks of radiosurgery after treatments of WBRT for stage IV metastasis breast cancer?

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What are the risks of radiosurgery (targetting one specific brain metastis) after two treatments of WBRT for stage IV metastiic breast cancer [HER2 positve]? Would this be a recommended course of action?
Posted Sun, 11 Aug 2013 in Cancer
 
 
Answered by Dr. Robert Galamaga 2 hours later
Hello and thank you for sending your question.

Your question is a very good one and I will work on providing you with some information and recommendations.

In the presence of a solitary brain metastasis it might be reasonable to consider stereotactic radiosurgery to target the dominant mass.

There may be short-term side effects including possible nausea as well as potential neurologic side effects. Therapists are very good today at targeting the tissue which needs to be affected by the radiation. This should help minimize toxic side effects.

This certainly requires a focused consultation and examination with a radiation oncologist. The radiation oncologist will calculate the dose of radiation needed to achieve a therapeutic response.

Again I think it is a reasonable consideration to consider targeted radiation in the setting that you have described.

Thank you again for sending your question. Please let me know if you have any additional specific concerns that you would like to review.

Dr. Galamaga
Above answer was peer-reviewed by
 
Follow-up: What are the risks of radiosurgery after treatments of WBRT for stage IV metastasis breast cancer? 3 hours later
I would like to clarify - there are 17 brain lesions. But only one is giving the patient problems due to its size. Would you still consider getting the targeted radiation?
 
 
Answered by Dr. Robert Galamaga 28 minutes later
Hello and thank you for the additional clarification.

If there is a dominant lesion which is causing symptoms it would be reasonable for the radiation oncologist to consider what we call a boost dose of radiation to that area. In my opinion the potential therapeutic improvement is significant enough to consider this as a possible option.

Again this is something you should discuss in great detail with the radiation oncologist. I would specifically ask him what he feels the absolute risks are And if he anticipates any risk of bleeding.

Thanks again for sending your question and clarification. Please let me know if I can be of any additional assistance.

Dr. Galamaga
Above answer was peer-reviewed by
 
Follow-up: What are the risks of radiosurgery after treatments of WBRT for stage IV metastasis breast cancer? 1 hour later
Her oncologist has recommended against the burst / cyber knife treatment as he worries that it will cause her quality of life to deteriorate. Currently she isn't in any pain, conscience, no real dementia to speak of.

His reasoning is that if zaps the dominant lesion, the radiation can diffuse through the brain and cause possible side effects (since she has already have two whole brain radiation treatments). For example, she may forget who her family is...
 
 
Answered by Dr. Robert Galamaga 22 hours later
Hello again and thank you for the follow up question.

As you know it is externally difficult to predict with any level of certainty what a response to the focused radiation might be. I would discuss this also in detail with the radiation oncologist as this physician can tell you with a higher level of certainty what to expect regarding side effects.

I realize this is a very difficult situation during which you are trying to balance the potential side effects of a treatment versus the likely progression of the tumor.

Ideally the patient should play a major role in deciding what to do next. Again this is an extremely difficult situation and I don't know if there is really a right or wrong answer.

Thank you again for sending your question. Please let me know if I can be of any additional assistance.

Dr. Galamaga
Above answer was peer-reviewed by
 
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