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Question About Brain Mets


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How large does a spot need to be on a Head CT before it is considered a met that needs treatment? May sound like a silly question, but I saw someone here reporting a 1mm nodule that will get treated soon. My mom had two 5mm nodules in May (they were mentioned in the written report, but not even visible on the CT scan pictures), which grew to 6mm in June, but the onc. said these were too small to tell what they were, that the 1 month growth wasn't enough to be concerned about now -- plus that these weren't big enough to be causing any symptoms.


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Keith had 12-13 mets. All of them very small and none causing any sypmtoms. He had WBR to treat the known mets and the ones that might be there but too small to see.

I would get another opinion. I'm a firm believer that it is better to treat a lesion before it becomes a problem and potentially can grow or spread to the point where it is no longer treatable.

Keith originally had 4 very small mets in his liver. The onc we had at the time said that he didn't want to do anything to treat them seperately, he wanted to do more systemic treatments. Plus they were very small and not something to be concerned with.

Well guess what, throughout most of this journey, Keith's tumors have been fairly stable with exception to the liver. They grew out of control and then next thing we are hearing is that it is the one thing of major concern and cause of pain, and they could have done cyberknife earlier, but now there are too many of them so they can do nothing.

It went from no big deal, to life threatening in no time. Doctors never know what is going to happen, and what is going to be a major problem for certain.

I hate that mentality. If there is something that can be done, even if it isn't the primary concern, fix it. Any degree less of cancer in the body has got to be a good thing.

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Hi Linda,

This is the second time I am having treatment for brain mets. Even though they are only 1mm, the surgeon and radiation oncologist feels that they should be treated immediately with radio surgery. It's just one dose of radiation and then it should be gone. Waiting to be symptomatic might preclude the use of the radio surgery and perhaps make the WBR necessary.

I am feeling well, live an ordinary life and in fact, my brother-in-law who is a doctor swears he would think I was misdiagnosed based on how I look and feel. With all that, I would prefer not to have the risks associated with WBR. Radio surgery is only performed where the mets are 4 or less.

By the way, since the first radio surgery on 3 other mets, I get MRI's every 3 months. And we'll just continue that for the time being.

I would ask why the onc is not taken action on the lesions they have found. And I might want to get a second opinion as well.

Good luck. If I can be of any help, let me know. (I'm seeing my radiation and regular onc next week and would be happy to ask any questions.)


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Read as much as you can get your hands on and then you as a patient should have a large degree of input in your treatment.

How big does a met have to be treated? How about zero? For sclc, PCI (prophylatic cranial irradiation) is given before any brain mets are even detected.

Since brain mets have a high ocurrence in sclc it was determined that giving radiation to the brain before any mets appeared lead to a survival advantage.

Simialar trials are being started on NSCLC.

Given that, you have to weigh all the pros and cons. Almost all treatments for cancer have some pretty bad side effects.

Good luck

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Hi Linda...maybe the mets are causing her confusion? They have cyberknife at Swedish Hospital in the James Tower, near Seattle University.

Seattle CyberKnife at Swedish Medical Center

550 17th Avenue, Suite A10

James Tower Life Sciences Building

Seattle, WA, 98122


Phone Main: (206) 320-7130

Don M

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