rwoodburn

I agree with the above that if the pain is persist and severe, it needs to be evaluated for a couple of reasons. One, it can be treated with radiation leading to pain relief. Secondly, a hip can be at risk for a dangerous fracture if the cancer has eroded the bone. It may need to be stabilized surgically if that is the case. It can be evaluated with plain film, MRI, and/or bone scan. MRI and plain film will give info on bone strength. Robert Woodburn M.D.

Another option is sterotactic body radiosurgery. It is a less invasive option compared to RFA. Robert Woodburn M.D.

Most departments do use masks so they do not need to mark on the person's face. There is nothing wrong with not using a mask. You should not be concerned. RW

linus, Metastatic brain tumor without a known primary can occur. It is not clear if the primary is simply too small to be detected or if the primary spontaneously disappears. Anyway, the prognosis can be good in this situation. Was radiotherapy given after the surgery? Bob

It can take months for the fatigue from wbi to ameliorate. Some people have fairly profound fatigue from the treatment. You should not be hard on yourself. It can be a difficult treatment.

Peggy, The following is a response to your request to describe the types and advantage of radiosurgery devices. Gamma Knife - Gamma Knife is the gold standard for radiosurgery. The GK was developed in Sweden in the 1970's. The Gamma Knife is still undesputedly the most precise radiosurgery device. It has no moving parts which enables the high degree of precision Linear accelerator based systems - novalis is an example of Linac based systems. They are generally not as precise as the Gamma Knife because they have a heavy head that rotates on a gantry. Moving parts always lead to some decrease in precion. The heavy head cause some bending leading to some decreased precision. Novalis has been able to effectively market there device on radio ads. I know that there have been a lot of ads on the radio in Indianapolis and I really think that they are unfortunately misleading. Novalis is a good tool but offers no advantage over Gamma Knife and one could argue that Gamma knife is better because of its increased precision. In fact there is one controversial study demonstrating better results for the gamma knife compared to linear accelerator systems. Cyberknife - the Cyberknife is a robot that has a linac attached to it. The cyberknife claims to be able to perform radiosurgery without an invasive head frame due to its sophisticated imaging/tracking system. The ability to not use a head frame is certainly an advantage. However, there has to be a loss of precision with this method. Also, there is some loss of precision secondary to moving parts and weight as seen in linacs. Now, having critiqued the devices, I must say that the precision that I am talking about probably makes no difference for brain metastasis. The Gamma Knife is accurate to withing 0.1 mm. The linacs are probably accurate to within 1.0 mm. However, the Gamma Knife precision is important when there is a tumor a few mm away from the optic nerves or other critical structures. Hope this helps. Robert Woodburn M.D.

jd, I am absolutely puzzled by the U of C doc's recommendation. I think that his recommendations are way, way off. Brain mets are a potentially lethal situation if not addressed. The good news is that if diagnosed when small ( his situation thanks to you) they can be eradicated with gamma knife radiosurgery. He absolutely needs to have these tumors taken care of. Please call if you need more advice. I feel bad that you are getting this kind of medical advice. I still am somewhat amazed that you received this recommendation. Were the tumor really in the brain? Robert Woodburn M.D.

Charlotte, I think that it is important for him to see his doctor. Even more important than taking care of the pain is the fact that if he has a spine tumor it could lead to paralysis if it starts to put pressue on the cord/nerves. You mentioned that he was having some problems walking. The problem walking could indeed be from pain, but it could also be from weakness. Sometimes it is very difficult to tell. The test of choice to rule this out is MRI of the total spine. Bone scan may help with the shoulder. Again, the most important issue is the possibility of cord damage leading to permanent paralysis. Keep in mind that the job of an ER doc is to make sure there is not an emergent situation at the time of visit. Remember, my advice is only based on your email. It is not even close to an evaluation. So, if his oncologist does not want to get the suggested tests, he may not suspect anything based on his thorough eval. Robert Woodburn M.D.

Bad effects of steroids: Decrease bone strength leading to fractures Stomach ulcers muscle wasting Decreases immune system leading to serious infections. Diabetes Robert Woodburn M.D.

Tami, I agree that it would be impossible to diagnose your situation without seeing and talking with you. You should see your doctor. It is certainly possible that your pain is a result of you surgical procedures and lymph edema. Your doctor can arrange physical therapy to treat your lymph edema and that will possible make your pain better it that is the cause of it. Robert Woodburn M.D.

Minnie, It is never good news to be diagnosed with brain mets but there is some reason to be optimistic. She only has three brain mets and these can usually be eradicated with current technology of whole brain radiation and radiosurgery. She has the potential to do very well. If she has nothing in other organs and was very functional, that is more good news for her. It is not true that when cancer comes back it is more aggressive. In fact, one good sign is your mother has done well for a year making me think that the cancer might be less aggressive. Don't give up hope. You never know how things will go. Robert Woodburn M.D.

It sounds like his pain is quite severe. With pain that severe, it probably warrants aggressive imaging to determine the cause, ie bone scan, ct scan and mri - specially since the ER doc recommended it.

Stereotactic radiosurgery is the name of the procedure. There are a few devices that perform that procedure - the Gamma Knife, the Cyberknife, and linear accelerator base systems of which there are many. The Gamma Knife is a the most precise device. Whether or not the slight increase in precision is important is controversial. I personally think that it is important but I do realize that it is my bias as I use one in my practice. The cyberknife is a frameless robotic system. Linac systems do use invasive head frames, like the Gamma Knife, for stereotactic radiosurgery. University of Pittsburgh is a leader in stereotactic radiosurgery. You may want to call a Gamma Knife center and they may be able to work with your insurance company.

Margaret, A solitary brain metastasis in the setting of NSCLC is controversial. The treatments can range from surgery followed by whole brain radiation to radiosurgery alone. In regards to WBR and Radiosurgery the options are as follows: 1. radiosurgery alone 2. WBR alone 3 WBR followed by radiosurgery Radiosurgery alone has the advantage of being a one day treatment with minimal side effects and risks if the size and location is appropriate. As mentiioned in the other posts, the main risks or WBR are decreased thinking ability and decreased memory. Neither are completely debilitating but the effects can be significant. The tumor should be less than 2.5 cm. The disadvantage is that there is a 30-40% chance of having additional tumors in the brain in the future. If additional tumor do occur, then repeat radiosurgery can be performed or a person could proceed with WBR at that time depending on the situation and the person's desires. WBR alone carries the above stated risks. WBR decreases the chance of developing additional brain tumors to around 10%. WBR alone has an additional disadvantage in that the chance of the visible brain tumors regrowing is very high (50-70%). The option of WBR followed be radiosurgery is the most aggressive treatment. It has the advantage of decreasing the chance of tumor developing elsewhere in the brain to 10% and controlling the visible tumor(s) 90-93% of the time. Of course, the risk of getting the effects from WBR would exist. Looking at all the studies, there does not seem to be a statistical impact on a person's longevity between the above options. It is a very controversial subject and most physicians have their biases. I believe that it is largely a personal decision, if of course, the clinical situation is appropriate for radiosurgery(small tumor size, low number of tumors, and other things). Gamma Knife is equipment that is used for radiosurgery. It is the gold standard and the most precise. Other types of equipment are linear accelerator based machines and a robotic machine named the cyberknife. The increased precision of the Gamma Knife may not be that important in most clinical situations. I would be happy to answer any questions. I think that a second opinion is a good idea. RW