Maureen's Medical Moment Monday, 9/26/2011

When cancer spreads from one area of the body to the brain it can be deadly.

Even if a tumor is removed, up to 40 percent of the time the cancer cells return.

Now, doctors are using an approach that saves time, and could save lives.

Beth Hoffer has traveled the world.
"I've been to Australia, New Zealand. I've been to Ireland and Eastern Europe, and Sweden and all over."

But the real journey of her life began five years ago when doctors diagnosed her with breast cancer.

"I remember when they told me it was cancer, I actually laughed because I was in such disbelief."

The news got worse. After three years in remission, the cancer spread to Beth's lungs. She had those lesions removed, but a recent scan showed the cancer had traveled to her brain.

Typically, surgeons remove the brain tumor and wait weeks for patients to heal before starting radiation, but that gives the cancer cells time to grow back. Doctors offered Beth a different solution, radiation seeds. First, they remove the tumor. Then, during the same surgery, they implant the seeds directly into the brain. It's like two procedures in one.

Gabriella Wernicke, MD, MSC, says, "By implanting the seeds into the surgical cavity right away, we essentially avoid the wait and therefore prevent the potential return of the tumor at the surgical site."

The seeds contain an isotope called cesium-131. Instead of traditional machines -- where beams have to pass through the skull and brain -- they deliver radiation directly to the tumor site.
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Theodore h. Schwartz, MD, says, "By delivering these seeds right into the cavity, we can give a very high dose of radiation focally to the bed of the tumor and prevent the radiation from spreading to the rest of the brain."

Cesium-131 allows radiation to be delivered quickly -- within about two weeks. The seeds are permanent, and patients only need one procedure.

Beth is cancer free, and hoping to stay that way.

Radiation seeds are used in other cancers, but this is the first time they've been used in cancer that has spread to the brain.

Doctors can implant anywhere from five to 35 seeds, depending on the size of the tumor area.

Patients who have the seeds do emit small doses of radiation.

Doctors told Beth she should try to avoid being around pregnant women and children for a few weeks.

RESEARCH SUMMARY

TOPIC: BRAIN SEEDS: PLANTING TUMOR FIGHTERS

BACKGROUND: Sometimes, cancer can start in one part of the body and spread to another area. This is known as metastatic cancer. Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer. For example, breast cancer that has spread to the lungs and forms a metastatic tumor is known as metastatic breast cancer. Under a microscope, metastatic cancer cells typically look the same as the original cancer's cells. Nearly all types of cancer, including cancers of the blood and the lymphatic system, can form metastatic tumors. The most common sites of cancer metastasis are the lungs, bones and liver. Some types of metastatic cancer can be effectively treated and cured, but most cannot. However, there are therapies available for all patients with metastatic cancer.
(SOURCE: National Cancer Institute)

SYMPTOMS: Some patients with metastatic tumors do not have symptoms. Their metastases are found via X-rays or other tests. However, when symptoms of metastatic cancer occur, the type and frequency of the symptoms depend on the size and location of the metastasis. For example, cancer that spreads to the bones will likely cause pain and lead to bone fractures. Cancer that spreads to the brain can cause a variety of symptoms including headaches, seizures and unsteadiness.
(SOURCE: National Cancer Institute)

TREATING BRAIN METASTASIS: When cancer spreads to the brain, it can be deadly. Up to 40 percent of the time, the cancer cells return even when a tumor is removed. Now, doctors are using a new treatment to fight cancer that has spread to the brain. Radiation seeds that contain an isotope known as cesium-131 are implanted directly into the brain during the same surgery that is performed to remove the tumor. Cesium-131 is a radioactive isotope with a shorter half-life and higher energy level than other agents in use. The seeds deliver radiation directly to the tumor site after they are implanted. The patient does not have to come in for daily radiation treatments because the seeds release a radiation dose tailored to individual patient needs.
(SOURCE: NewYork-Presbyterian Hospital/Weill Cornell Medical Center)


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