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Whole-brain Radiation- Metastasis?

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Hi David. In April I was diagnosed with Lung Cancer.   I underwent 13 rounds of chemotherapy.  The mass in my lung shrunk to 1/3 of its size.  I  was sent for radiation to eradicate the smaller cancer tumor (right).   On  the last day of my radiation my oncologist told me that she wanted me to undergo whole-brain radiation.

I told my oncologist that I thought that I would sustain brain damage from the WBR so I said declined the therapy.  My oncologist then ordered an MRI of my brain  and  I went from zero lesions in my brain 3 months previously  to 22 microscopic lesions.

Reluctantly, I agree to 10 whole-brain radiation treatments.   My oncologist told me  the side effects would make me a little slower, and my hair might fall out.

My oncologist suggested that I take a drug called memantine  to protect my memory.  My memory is fine right now. but I believe that memantine also has side effects.

While undergoing whole-brain radiation, I noticed that some sessions were longer than others. I thought I  was suppose to receive the same treatments every day. I had several days  with 30 second or under on each of 5 treatments then on other days I had 2 that took 67 sec and 3 under 30 seconds.  

My oncologist says that I received  300 Sv  of radiation each time but seems to me they should have all lasted the same amount of time.

I am 67 years old  but I swear she got mad because i handled the treatments better than others my age  and younger. I have one radiation treatment left and I’m considering not going.  

  • What do they plan to do tomorrow that will make me need mematine?  
  • I really need some help. I feel a lot of this is for money not my health.
  • What do you think?

To learn more about palliative care for cancer patients read the posts below. 


Hi Jill-

First and foremost, I am sorry to read of your Lung Cancer diagnosis.  Therapies for LC can be difficult even in the best of cases. From your post, it sounds as though you understand how difficult Lung Cancer is to treat. Shrinking your lung tumor with chemotherapy was a successful first step.
It is also great to read that you are handling all of your therapies well. You’ve gone through hell over the past months and you have enough energy now to research your therapies.
My guess is that you also understand how common it is for Lung Cancer to metastasize to the brain. I am no expert on lung cancer but my understanding is that your brain mets, though microscopic, were a sort of no-win scenario. Whole-brain radiation would buy you more time but make you “slower.”
Having said that last sentence, I will admit that, in general, oncology thinks first and foremost, of doing anything they can for their patients to live longer. Regardless of what the patient feels.
I have no experience with memantine but it sounds like the only therapy that your oncologist can prescribe for the brain damage caused by whole-brain radiation. Memantine is supposed to slow dementia.

To answer your question then, I would finish the last course of radiation. I think doing everything you can to zap your brain mets will help you in the long run.

But as to the larger issue of your oncologist prescribing whole-brain radiation, I will go back to the begining of this reply by saying that you are in a no-win situation. Or I should say that whole-brain radiation is the lesser of two evils, at least in your oncologist’s mind.

I too have sustained severe side effects as a result of radiation. I too wonder if too much radiation caused my nerve damage. All I know for sure is that I was experiencing a lot of bone pain and that the radiation stopped the pain (killed the lesions in my bones).

I consider my radiation to have been palliative, not curative therapy. I think your whole-brain radiation therapy was palliative as well.

On the topic of how oncologists are compensated, I agree with you in that I firmly believe that money influences how oncologists prescribe therapies. Having said that, I don’t know that your oncologist made more money by increasing the amount of radiation that you had. I just don’t know.

I think it makes more sense to talk about possible therapies to treat the radiation fibrosis that you have undoubtedly sustained. If the study linked below is correct, I think it is in your interest to get as many HBO treatments as you can afford, as soon as you can.

Click now to learn more about hyperbaric oxygen therapy-

Let me know if you have any questions.

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Memantine 

is a medication used to slow the progression of moderate-to-severe Alzheimer’s disease.[2][3] It is taken by mouth.[2]

Common side effects include headache, constipation, sleepiness, and dizziness.[2][3] Severe side effects may include blood clots, psychosis, and heart failure.[3] It is believed to work by acting on NMDA receptors, working as pore blockers of these ion channels.[2]

Hyperbaric Treatment Of Brain Radiation Necrosis

“Delayed effects of radiation therapy can include radiation necrosis of the brain, which generally occurs in the area of the brain where the tumor was radiated. Radiation-induced brain tissue necrosis can occur anywhere from 6 months to several years after the radiation treatment, but it usually occurs within the first 1 to 2 years…

Hyperbaric oxygen therapy (HBO2) has no double-blind placebo-controlled trials to prove its efficacy, but many case studies and prospective studies demonstrate some benefit.

HBO2 promotes tissue healing by improved angiogenesis that results in better tissue perfusion. Hyperbaric oxygen therapy also can reduce tissue edema and enhance collagen synthesis by fibroblasts which activity is crucial for the healing of damaged tissue…

HBO2 helps to restore normal cellular functions to aid the repair of the ischemic damaged tissue. It is important to note that the angiogenesis that occurs with hyperbaric oxygen therapy produces a vascular supply to the radiation damage tissue that is more robust than the telangiectasia that sometimes occurs as a part of the radiation necrosis.

HBO2 usually is delivered at a dose of 2 to 2.4 atmospheres absolute for 90 to 120 minutes daily and may take 20 to 30 treatments before significant angiogenesis occurs with the improvement of the neurologic symptoms.

The major disadvantage of hyperbaric oxygen therapy is that it is expensive, time-consuming, and universally not readily available, although this later problem is becoming less of a concern as more facilities are built.

More studies on the use of hyperbaric oxygen therapy alone and in conjunction with other therapies, such as concomitant steroids and surgery, are needed to determine the best treatment practices.

 

 

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