Metastatic brain tumors
Minimally invasive surgery & precision radiosurgery are often essential first steps in treating Metastatic brain tumors
Metastatic brain tumors most commonly arise from cancers of the lung, breast, skin (melanoma), colon, kidney & thyroid
Optimal personalized treatment of patients with metastatic brain tumors requires a team approach of medical and neuro-oncologists, radiation oncologists and neurosurgeons, as well as cutting-edge brain imaging and tumor genetic profiling. Treatment of the cancer in the body, needs to be coordinated with “brain-directed” therapies in a targeted and precise fashion.
The initial treatment of metastatic brain tumors is typically focused radiation (radiosurgery) and/or surgical removal depending upon the type, size, location and number of metastases. Fortunately, for patients who require metastatic brain tumor surgery, most can be removed through a minimally invasive keyhole approach. The goal of surgery is to achieve maximal safe tumor removal and improve quality of life. An additional goal is to obtain tumor tissue for histological subtyping and genetic profiling for novel targeted therapies options and clinical trials, which are increasingly available for patients with metastatic brain tumors.
At the Pacific Brain Tumor Center we incorporate cutting-edge technology such as MRI fiber tractography, functional MRI, surgical navigation, awake craniotomy protocols, and high-definition endoscopy, with proven surgical experience, to make metastatic tumor surgery safer, less invasive and more effective. We also have a large experience in the radiosurgical treatment and comprehensive care of all types of brain metastases. Our metastatic brain tumor surgeons Drs. Daniel Kelly & Garni Barkhoudarian work closely with our radiation oncologists, medical-oncologists, neuro-oncologists and neuropathologists to design the optimal treatment plan.
Metastatic brain tumors (also known as secondary brain tumors) arise from a cancer from another part of the body and occur in 10 – 30% of cancer patients. These are the most common type of brain tumor occurring 5 – 10 times more commonly than Primary Brain Tumors. In the United States, with over a million new cancer patients diagnosed each year, 100,000 to 300,000 of these people will develop brain metastases. The most frequent types of cancer that metastasize to the brain are lung, breast, melanoma (skin), colon, renal (kidney) and thyroid.
Symptoms of a metastatic tumor or tumors are variable and depend on the location; common complaints include headache, seizures, weakness, numbness, imbalance or in-coordination, confusion and personality changes.
The diagnosis of these tumors is typically made by a brain MRI with and without contrast which will show the exact location and number of metastatic tumors. A CT scan without and with contrast will reliably show the number and location of metastatic brain tumors.
For larger symptomatic brain metastases over 2-3 cm in diameter with associated brain swelling, surgical removal through a Keyhole Craniotomy is often indicated. In other patients with one or more smaller tumors, particularly those that are not easily accessible by surgery, precision radiosurgery (SRS) is typically used. In many patients with multiple brain metastases, keyhole surgical removal of symptomatic larger metastases is combined with radiosurgery to smaller metastases and the surgical resection site. Whole brain radiotherapy which involves radiation of the entire brain is avoided whenever possible.
Coordinating these “brain-directed” treatments with treatment of the cancer elsewhere in the body is essential to gaining control of the cancer. Fortunately, with advances in tumor genetic profiling, novel chemo- and immunotherapies and related clinical trials are available for many of our patients. One key purpose of metastasis removal is obtaining tissue for genetic profiling agents and there are always new therapies in development.
For more information about clinical trials at the Pacific Brain Tumor Center and with our colleagues in medical and neuro-oncology.
To watch metastatic brain tumor surgery, go to our video library.