Observing the Effect of Patient’s Life Treatment

The standard for treating brain metastases back in 1954 was whole brain radiation therapy. The intent of whole brain radiation therapy is to help deal with cancer that spread to the brains by treating the whole brain, all of it, with radiation, whole brain radiation remained the standard of care for brain metastases. I observed that the effects of the cancer treatment were often worse than the disease itself with respect to the patient’s quality of life. Patients always had moderate to severe problems with brain function after treatment. How bad was it? Let’s say if they could balance their checkbook prior to treatment, they weren’t likely to be able to after. Other negative effects included memory problems, being able to understand, and other changes in how they were able to think and do things prior to treatment. The benefit of the cancer treatment was that the patients could live a few months longer but the downside was very significant.

Fifty years later the standard for treating brain metastases is still whole brain radiation. What? How can this be true with all the advances in medical science over the last 50 years? How can this be true when treating brain metastases, using radiosurgical techniques with CyberKnife and other machines, is readily available? According to the Wall Street Journal article, “Cancer Radiation Questioned,” 200,000 patients with brain metastases are subjected to whole-brain radiation therapy for brain metastases each year. What alternatives are there? Treating brain metastases with radiosurgical techniques, such as with CyberKnife and other machines, is readily available and is not associated with the consequences of whole brain radiation. Discovering a brain tumor is overwhelming, and it’s natural to want the most advanced and effective treatment available. In order to effectively fight the disease, the treatment of brain tumors often requires combinations of several types of strategies to either shrink or remove the tumor, as well as potentially minimize side effects or pain of the tumors themselves. For singular tumors not near the brain’s most critical structures – such as those regulating breathing or involved in vision – typical cancer treatment involves surgically removing the tumor.

Surgery is a common cancer treatment for cancerous primary brain tumors, such as a glioblastoma multiforme, as well as solitary brain metastases and benign tumors. Surgery is often followed by whole-brain radiation or partial-brain radiation techniques to eliminate any microscopic bits of the tumor. In some cases, oncologists (cancer doctors) combine chemotherapy and surgery when treating malignant brain tumors for greater effect. In the last three decades, an advanced technology known as radiosurgery has emerged as an alternative to surgery for several types of cancer. Unlike conventional radiation therapy, in which small doses of radiation are dispensed over weeks and months, radiosurgery can treat a tumor in one to five sessions using a high dose of radiation with extreme accuracy. During radiosurgery, hundreds of narrow radiation beams attack the tumor from different angles. This precise cancer treatment targets the tumor without damaging the surrounding healthy brain tissue. In order to be effective and safe, radiosurgery must be accurate. After local anesthesia is given, a specialist screws these frames into a patient’s skull. Patients sometimes find these frames uncomfortable and painful. In addition, if multiple cancer treatment sessions are required, the patient may have to be hospitalized with the frame in place for several days until the treatment is complete.