Brain Tumors

Brain metastases or primary brain tumors (glioma)

Treatment options Side effects of treatment

Brain metastases: cancer that started elsewhere in the body (e.g. lung or breast) and spread to the brain

Brain primary: a normal brain cell (glial cell) becomes malignant and is called a glioma

Brain Function

The most common causes of brain metastases in adults with their approximate frequency are:

    Lung — 50 percent    Breast — 15 to 20 percent    Unknown primary 10 percent    Melanoma — 10 percent    Colon and rectum 5 percent

The distribution of metastases roughly follows the relative weight of and blood flow to each area.

    Cerebral hemispheres — 80 percent    Cerebellum — 15 percent    Brain stem — 5 percent

SYMPTOMS OF BRAIN METASTASES

Symptom Patients % Headache 42 Focal weakness 27 Mental change 31 Seizure 20 Gait ataxia 17 Sensory disturbance 6 Speech problems 10

Brain Imaging

Whole brain irradiation

Whole brain radiation

The response or benefit from whole brain radiation takes several weeks to months

Typical response for whole brain radiation

Typical response for whole brain radiation

Typical response for whole brain radiation

Small tumors may be gone completely by two months

Radio resistant cancer (renal cell) MRI appearance two months after whole brain radiation (small lesions gone and large lesion much

smaller)

Cyberknife Radiosurgery for Brain Metastases

Typical time interval to regression after radiosurgery Cyberknife or Gamma Knife)

How often does brain radiation help?

• 70 -90% initial response • > 50% of symptoms of headache, CSF pressure have complete response • 50 -60% have functional improvement

moderate dysfunction: 1/3 near normal at median time of 3 weeks severe dysfunction: 2/3 improve at median of 1-2 weeks

Side Effects of Brain Radiation

1. Hair loss (usually takes two or three weeks to happen)

2. Mild skin itching or irritation

3. Short term more fatigue or slightly more confusion or memory problems

4. Mild headache or nausea is uncommon but may require medication (Decadron)

5. Occasionally hearing problems (fluid behind the ear drums)

Radiation prescription for #

Diagnosis: #

External radiation: #

Internal radiation: #