Brain Metastases Treatment

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.