Brain Metastases Services

The Approach to Brain Metastases Treatments at RUSH MD Anderson

Finding out that you have brain metastases — cancer that has spread to your brain — is overwhelming. But having specialists on your side who understand these tumors and will explain your options can help you feel confident in decisions about your care.

RUSH MD Anderson Cancer Center specialists in Chicago and the surrounding area review each patient’s case with a team of neuro-oncologists, neurosurgeons, radiologists and radiation oncologists. They work together to form custom treatment plans along with experts in primary cancers that cause brain metastases.

There are several care options for brain metastases. Sometimes these treatments are used alone, but many are used in combination with other treatments.

Treatment options for brain metastases include the following:

• Surgery: The goal of surgery is to remove all or as much of a brain tumor as possible while preserving brain function. This can help reduce the size of tumors and ease symptoms. It also helps oncologists plan follow-up treatment. Craniotomy is the most common type of surgery for brain metastases. It involves removing a section of the skull to remove the tumor.
• Radiation therapy: Many tumors, especially those that are difficult or impossible to safely remove with surgery, are treated with radiation therapy. It involves using powerful beams of focused energy that can stop or slow the growth of tumor cells by damaging their DNA. Sometimes it is used as a treatment on its own, and sometimes it is used in combination with other therapies, often after surgery to prevent tumors from recurring. Some radiation therapy methods include the following:
  • Stereotactic radiosurgery (SRS): High doses of radiation are delivered precisely to the tumor from many different angles. 3D imaging guides planning and treatment. This helps prevent radiation exposure to healthy tissue around the tumor. One advantage of SRS is that it generally only takes one to five treatments. It is performed as an outpatient procedure, meaning patients can go home the same day and get back to their normal activities within a few days. A medical linear accelerator (LINAC) one type of SRS used by RUSH MD Anderson specialists that is similar to Gamma Knife technology that other medical centers may use.
  • Intensity-modulated radiotherapy (IMRT): As with SRS, imaging and 3-D models help guide treatment. It allows radiation beams to aim at the precise shape of a tumor.
  • GammaTile: This therapy is used after surgically removing as much tumor tissue as possible. The neurosurgeon then places GammaTiles, which are titanium, radiation-emitting capsules enclosed in collagen, at the site of the tumor. The incision is closed, and the tiles deliver a dose of targeted radiation over the course of several weeks, which can prevent or delay a tumor from recurring. The body then reabsorbs the collagen, and the capsules become inert. One advantage is that patients don’t need to come to the hospital for radiation treatment once the tiles are in place.
  • Whole-brain radiation therapy (WBRT): For patients who have several tumors or leptomeningeal disease, radiation therapy can target the whole brain. This usually involves several treatments over the course of about two weeks.
• Chemotherapy: This type of therapy targets fast-growing cells, such as those that make up a tumor. Because of the blood-brain barrier, many medications, including chemotherapy, have difficulty reaching the brain. But specialists can treat some cases of LMD by making a small hole through the skull to deliver chemotherapy drugs directly into the cerebrospinal fluid.
• Targeted therapy: For cancer cells to multiply, they need specific molecules that are made by cancer-causing genes. The cancer cells themselves make these molecules too. Targeted therapy, also called precision medicine or targeted drug treatment, relies on medications that interfere with these molecules and the genes that produce them, which can slow or stop cancer growth. The drugs can be in pill form or delivered intravenously through an infusion.
• Immunotherapy: Supporting the body’s immune system can improve its ability to fight off cancer, and there are several types of drugs, vaccines and other therapies that can help. Some boost cancer-fighting cells, called T cells, while others help the immune system better identify and respond to cancer cells.
• Clinical trials: New care options for brain metastases are always being researched and developed. Many of these cutting-edge treatments are only currently available through clinical trials. Your specialist can discuss whether you’re a good candidate for these new treatments. You can find more information on our clinical trials page.

Second Opinions for Brain Metastases

If you would like to learn more about care options for your brain metastases or better understand your diagnosis, you may want to get a second opinion. It can help you know what treatments are available and feel confident in decisions about your care.

To schedule an appointment for a second opinion, call (888) 352-7874. You can also learn more on our Getting a Second Opinion page.

What Are Brain Metastases?

Brain metastases, also called metastatic brain tumors or brain mets, are tumors that grow in the brain from cancer cells that have spread from another part of the body.

The original tumor that these cancer cells come from is called a primary tumor. The primary tumor can be anywhere in the body, but it is most often a form of breast cancer, lung cancer or melanoma, which is a type of skin cancer.

Brain metastases are far more common than primary brain tumors — tumors that start in the brain rather than spreading, or metastasizing, from somewhere else. In fact, they are the most common brain tumors in adults, and the risks increase after age 45. Most patients are diagnosed after age 65.

The symptoms of brain metastases depend on the size and location of the tumor or tumors. Some of the most common symptoms include the following:

• Headaches
• Seizures
• Weakness, especially on one side of the body
• Movement issues, such as loss of balance and coordination
• Aphasia, or difficulty speaking and understanding speech
• Confusion or changes in cognition, mood or personality
• Vision problems
• Sensory changes
• Changes in pulse or breathing

Causes of Brain Metastases

Brain metastases grow when cancer cells move to the brain, usually via the bloodstream, from a primary tumor somewhere else in the body. About 20% to 40% of people who have other types of cancer develop metastatic brain tumors. The types of cancer that most commonly cause brain metastases are lung cancer, breast cancer and melanoma.

But many types of malignant cancer can spread to the brain. These include colon cancer, gynecologic cancers, thyroid cancer, renal cell carcinoma or kidney cancer and many others.

Brain Metastases Diagnosis

The process for diagnosing brain metastases often begins when an oncologist suspects a patient’s malignant primary tumor may have spread to the brain.

But sometimes patients who don’t yet have a primary cancer diagnosis need further testing to reveal where else in the body the brain metastases may have spread from.

Some of the ways oncologists can diagnose brain metastases include the following:

• Neurological exam: This can include asking the patient about symptoms, including changes in mood, senses, speech or coordination, as well as seizures or headaches. It can also include reflex, cognition and sensory tests. These can tell the oncologist which parts of the brain are being affected by a possible tumor.
• Magnetic resonance imaging (MRI): Imaging can indicate the presence of a tumor in the brain. It’s the most common way brain metastases are located and diagnosed. Sometimes brain metastases are discovered incidentally through imaging for other conditions, especially other types of cancer.
• Biopsy: An oncologist might need to take a sample of a tumor for testing. They can perform a biopsy through surgery or, in some cases, with a needle and navigation equipment.
• Lumbar puncture (spinal tap): One type of brain metastasis called leptomeningeal disease, or LMD, can be diagnosed by taking samples of cerebrospinal fluid, or CSF. This can be done through a needle inserted into the lower back.