Spring 2005

Brain Metastasis

The most common brain cancer is a metastasis of a primary cancer located elsewhere in the body. Ten or 15 years ago, the discovery of a stage-IV metastatic brain tumor was usually a death sentence, says Dr. Michael McDermott, a UCSF neurosurgeon. "That would have been the signal to stop all treatments of the systemic cancer."

That is no longer true. With therapeutic advances, metastatic brain cancer has become far more treatable and now is usually a threat secondary to that posed by the primary cancer. "Even when there is a metastatic brain tumor, 90 percent of the time it is the primary cancer that is the biggest threat," McDermott says.

The range of treatments seem much the same as they were a decade ago. Therapeutic options then and now are surgery, brachytherapy —- in which radioactive seeds are placed in or near the tumor —- whole brain irradiation, radiosurgery and chemotherapy.

Although the basic therapies remain constant, their use continues to change. The main controversies in recent years have been about how and when to use each of these techniques, and how and when to combine them. UCSF researchers have conducted a number of clinical studies to determine which combination of treatments offers the best outcomes for metastasized brain tumors derived from various kinds of primary cancer.

For instance, Dr. Penny Sneed, a UCSF radiation oncologist, conducted a retrospective review comparing radiosurgery (RS) alone to whole brain radiotherapy (WBRT) and RS in combination. Survival time did not appear to be adversely affected by omitting WBRT and only three-quarters of the patients managed initially with RS alone ultimately needed WBRT. This is important because the neuropsychiatric side effects of WBRT can be significant a year or more after WBRT.

Results from such clinical studies over the last decade, McDermott says, have both increased the effectiveness of these brain tumor treatments and reduced the collateral damage to other brain cells.

"What we try to do with patients referred to us for metastatic brain tumors is successfully treat them and get them back home so that the referring oncologist can treat the primary cancer," McDermott says.

Dr. Penny Sneed may be contacted at (415) 353-8900. Dr. Michael McDermott can be contacted at (415) 353-7500.

Related Information

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Brain Tumor Treatment Varies Greatly
Primary malignant brain tumors are uncommon and often associated with a poor prognosis. A new study found that treatment of these tumors varies greatly among medical centers and can conflict with accepted guidelines of care.