Your brain metastasis treatment can be planned by a team of experts in neuro-oncology, neurosurgery, radiation oncology and radiology, as well physicians who specialize in the primary cancers most likely to spread to the brain. This group meets every week to review new brain metastasis cases and develop treatment plans designed to give each individual patient the best possible outcome.
Brain metastases surgery
Depending on the number, size, location and symptoms caused by the brain metastasis, surgery may be an option. Surgery is used most often for single, large brain metastases. Like all surgeries, brain metastasis surgery is most successful when it is performed by a specialist with a great deal of experience in the particular procedure. This is especially true with brain metastases because it is crucial to remove as much of the tumor as possible while preserving brain function.
MD Anderson neurosurgeons are among the most skilled and recognized in the world. They perform a large number of brain tumor surgeries each year, using the least-invasive and most advanced techniques.
Even when complete removal of a brain metastasis is not possible, surgery may be able to:
- Help reduce the tumor’s size.
- Relieve symptoms.
- Help doctors determine what other treatments are needed.
The most common surgery for brain tumors is craniotomy, which involves removing a section of the skull to expose the brain, followed by resection (removal) of the tumor. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make them difficult or impossible to remove without destroying important parts of the brain. In these cases, doctors rely on other treatments.
Radiation therapy for brain metastases
Radiation therapy may be able to stop or slow the growth of brain metastases. It may be used alone, as an alternative to surgery, or in combination with other treatments.
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson uses the most advanced radiation treatment methods, including:
- Gamma Knife stereotactic radiosurgery, which is not really surgery. It delivers a powerful, precise dose of radiation from various angles. This allows doctors to treat the metastasis with minimal damage to surrounding brain tissue.
- Focused radiation therapy, which is aimed directly at the tumor and immediately surrounding area.
- Whole-brain radiation therapy, which may be recommended if you have multiple brain tumors.
- Intensity-modulated radiotherapy (IMRT), which shapes the radiation beam to the shape of the brain tumor and lessens exposure to the rest of the brain.
Radiation therapy may or may not be an effective treatment for your brain metastasis.
Chemotherapy for brain metastases
Chemotherapy was previously not a primary treatment for most brain metastases. This is largely due to the blood-brain barrier, a membrane that separates circulating blood from the brain. This barrier limits many pathogens (such as bacteria and viruses) from spreading to the brain. It also prevents many medications, including most chemotherapy drugs, from reaching the brain.
However, recent research has shown several promising chemotherapies may play an important role in treating some brain metastases.
In some cases, chemotherapy may be used to treat leptomeningeal disease. To administer the chemotherapy, doctors must first drill a small hole in the skull and insert a special port, called an Ommaya reservoir. This allows doctors to deliver the drug directly into the cerebrospinal fluid. This technique, called intrathecal chemotherapy, can only penetrate a few millimeters into the leptomeninges. If the tumor is any thicker, doctors may first try to shrink the growth with radiation.
Laser interstitial thermal therapy
Laser interstitial thermal therapy (LITT) is performed by inserting a laser probe into the tumor and heating it to temperatures high enough to destroy the tumor. The treatment is minimally invasive. It only requires a small incision. This makes LITT an option for metastases that can’t be removed with surgery due to their location. Most patients who undergo LITT can go home the day after treatment and quickly return to normal activities.
Immunotherapy for brain metastases
Immunotherapy uses the body’s own immune system to fight cancer. These treatments are relatively new and are proving effective in treating melanoma brain metastases, but are still being studied in other tumor types.
Targeted therapy for brain metastases
Targeted therapies target the specific gene mutations that cause cancer. Several of these drugs are under investigation in clinical trials for patients with specific types of cancer.
A brain tumor diagnosis and treatment can bring many questions. That’s why John de Groot, M.D., co-leader of our Glioblastoma Moon Shot™, and Jeffrey Weinberg, M.D., recently took time to answer questions submitted online by brain tumor patients and caregivers.
Here are their responses to eight of the top questions we received about brain tumor treatment.
What treatment options are available for patients facing a brain tumor recurrence?
Weinberg: If there’s a mass that can be safely removed, we remove it. This may alleviate symptoms and allows us to verify whether it’s truly a recurrence, or something else (like dead tissue) that just looks like a tumor on the MRI. Removing the tumor tissue also allows us to perform molecular analysis to see if the patient is eligible for a clinical trial.
What if my brain tumor is inoperable?
Weinberg: Whether a brain tumor is operable depends on its size, location, the symptoms it’s causing and the experience of the operating team. We perform many second opinions for patients with “inoperable” tumors. Because of the experience of our neurosurgeons and the technology available at MD Anderson, we’re able to safely operate on many tumors that would be considered inoperable somewhere else.
We also have options to treat inoperable tumors without physically removing them, including laser interstitial thermal therapy (LITT).
How and why are low-grade gliomas treated differently than more aggressive brain tumors like glioblastoma?
de Groot: “Low-grade glioma” typically refers to a grade II astocytoma or oligodendroglioma. Several recent Phase III clinical trials have shown that oligodendroglioma is very treatable and that patients with this disease can live for many years after treatment. With good survivorship for low-grade gliomas, we want to minimize the potential impact of aggressive therapy to the brain, which can affect quality of life.
How do you treat cancer that spreads to the brain from elsewhere in the body?
de Groot: Solid tumor cancers such as lung cancer, breast cancer and melanoma can spread to the brain. These tumors are called brain metastases. For a single tumor, we may consider surgery. If there are multiple tumors, radiation or radiosurgery is typically used. Now, targeted therapy and immunotherapy are also options for some patients.
Weinberg: We recently started a tumor board for patients with metastatic disease. This allows MD Anderson oncologists to meet with our neuro-oncology, neurosurgery and central nervous system radiation oncology teams to create a tailored treatment plan for each patient with brain metastases.
What are the most promising developments in brain tumor treatment?
Weinberg: We’re discovering and treating metastatic brain tumors when they’re smaller, thanks to earlier MRIs. For primary brain tumors, we’re now imaging functional brain nerves (which control movement, speech and other important functions) with greater accuracy and using that information in our surgical plan. That makes surgery safer.
Metabolic imaging is a new technique that helps us interpret changes in the tumor that develop over time. It’s also helping us differentiate between tumor regrowth and lesions caused by brain tumor treatment.
Laser interstitial thermal therapy is another promising development that appears to be very effective in treating certain tumors. Laser interstitial thermal therapy works by inserting a probe directly into the tumor and heating it enough to destroy the tumor from the inside. Real-time MRI temperature monitoring makes it possible to do this safely.
What’s the status of developing immunotherapy for glioblastoma?
de Groot: We’re currently introducing immunotherapy treatments to glioblastoma patients through clinical trials. From what we’re seeing, the checkpoint inhibitors that have worked in melanoma and lung cancer are probably not a home run for glioblastoma. We’re now testing combination therapies that combine a checkpoint inhibitor with another therapy in clinical trials.
Other immunotherapy trials use a patient’s own cells, like T cells or natural killer cells, and reprogram them to attack the brain tumor. We’re hopeful that immunotherapy will make a big difference for glioblastoma.
What other types of clinical trials are available for brain cancer?
de Groot: Besides immunotherapy, we have two other types of clinical trials:
- Targeted therapy for tumors that have specific molecular markers
- Biologic therapies using Delta-24, a cancer-killing virus developed at MD Anderson
We also have trials for meningioma, leptomeningeal disease and other brain tumors. See our brain tumor clinical trials here.
What’s your advice for brain tumor patients and caregivers?
de Groot: You’re an individual, not a statistic. You’re not going to have the same experience as other brain tumor patients. Live every day to its fullest and stay optimistic, with the expectation that none of us can predict exactly what’s going to happen.
Weinberg: Remember, it might be your first time going through brain tumor treatment, but it’s not ours.
Watch answers to more brain tumor questions in this Facebook video Q&A.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.