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progression after WBR


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I was wondering how common it is to have growth (even if only slight) and progression for very small 2-4mm brain mets after receiving wbr. I was told I have 6 brain mets and I completed my wbr on Oct. 15th. My follow up MRI showed slight growth and progression in the lesions.

Is this unusual, or do you see it happen. I thought since they were so small to begin with, they would be gone after wbr. Thanks for any insight.


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That is pretty unusual but rarely happens. I would definitely not get too excited until they get follow up scans though, those first scans can be very misleading. Let me tell you a story:

I take care of a young man who was diagnosed with a very nasty brain tumor (glioblastoma multiforme) about a year ago. We treated him with chemotherapy and radiation together. He initally did OK but about 2 months after his treatment was finished he was doing very poorly and was admitted to the hospital with uncontrolled seizures and was near comatose. During the hospitalization, we did an MRI which showed clear progression of his cancer with lots of swelling. The neurosurgeon saw him and unfortunately felt there was nothing more he could do. He enrolled on hospice and I told his wife that I didn't think he would make it long, a couple weeks or a couple months at most. I put him on decadron to control the swelling.

3 months later he came to clinic for a hospice checkup. I was very surprised to see him as I honestly didn't think he'd live that long. In fact, he was up and around and outside of some memory problems was doing surprisingly well. We decided to get a brain MRI to see what was going on. As I would have expected, it looked even worse and the tumor was continuing to progress. We discussed trying an experimental chemo protocol but they were very happy with the hospice services and didn't want to do anything.

About 3 months later hospice contacted me and told me that his hospice time (6 months) was basically up and I'd need to see him again to re-enroll. He came in with his wife and again looked remarkably good except for the effects of the decadron. We again got an MRI and this time it looked dramatically better. The only way I can explain this is that what we were looking at that looked like cancer growth was actually just changes from the radiation. Needless to say, we took him off hospice (he missed them already!) and he's looking at going back to work.

Anyways, moral of the story is: don't put too much into that first MRI. Brain MRI's after radiation can be a little dicey to read especially that soon after treatment.

Final sidenote on that story: his wife is absolutely furious with me. She is not very fond of him and states I promised that he would die and is very angry that he is no longer dying!

Just can't seem to please anyone these days.... :)

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Dr. Joe,

Thank you so much for your story of hope. I will keep a positive thought that my MRI was just too soon to be able to tell what is ultimately going on.

As far as your patient is concerned, he needs to kick that wife "to the curb!"

I really appreciate your input and hope to have better results on Jan. 5th.


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