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What to Know About Metastatic Lung Cancer That Has Spread to the Brain

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How Brain Metastases From Lung Cancer Are Treated

If diagnosed and treated early, brain metastases usually respond to therapy. Your treatment plan will depend on your tumors (size, number, location in the brain, and genetic characteristics); the extent of disease outside the brain; and your overall health. Treatment may include:

Surgery Surgery may be an option for people with only one or two brain metastases that are easy to access and remove. It may also work for people who have a larger tumor that’s causing compressive symptoms, according to Mayo Clinic, which notes that removing even a portion of the tumor may help alleviate symptoms. According to the Translational Lung Cancer Research review, surgery is commonly followed by radiation therapy.

Radiation This therapy uses X-rays or other high-energy beams to kill cancer cells. Different methods of radiation are used to treat brain metastases.

People who have smaller brain tumors or tumors that are not surgically accessible or are too advanced for neurosurgery may be good candidates for stereotactic radiosurgery, in which MRIs, CT scans, and computer guidance are used to deliver large doses of radiation directly to tumors, according to Memorial Sloan Kettering Cancer Center (MSK). “This approach can effectively treat metastases with little radiation exposure to other parts of the brain and with minimal side effects,” says Dr. Goldman.

If you have many tumors throughout your brain or a large tumor deep in the brain, your doctor may recommend whole-brain radiation, in which radiation is applied to the entire brain to kill tumor cells, according to Cleveland Clinic. “This method,” Goldman explains, “treats the whole area but, unfortunately, comes with more side effects, such as headache, fatigue, nausea, hair loss, and some slowed cognition.”

Systemic Therapy With systemic therapies, including chemotherapy, immunotherapy, and targeted therapy, drugs travel through the bloodstream to reach cancer cells throughout the body.

Because many chemotherapy drugs are unable to cross the blood-brain barrier — a network of capillaries that keeps certain substances from reaching the brain — targeted therapy is the primary form used to treat brain metastases, according to an article in the journal Neuro-Oncology Advances.

Targeted therapies can identify and attack specific cancer cells with minimal harm to normal cells. For people with lung cancer cells that have specific mutations (such as EGFR and ALK), these therapies can be highly effective.

But if your lung cancer doesn’t carry these specific mutations or has spread elsewhere in the body, your doctor may consider other systemic therapies, such as immunotherapy (which uses medicine to activate your own immune system to recognize and kill cancer cells) or chemotherapy.

Palliative Care This type of specialized medical care can include pain management, mental health counseling, spiritual support, and stress management techniques. It’s a key component of treatment for patients with metastatic NSCLC, according to Memorial Sloan Kettering Cancer Center.

Palliative care can help mitigate the side effects of both the cancer and its treatment and significantly improve quality of life. Information and support are available for people with lung cancer and their families at Go2 for Lung Cancer, the American Cancer Society, and the Global Resource for Advancing Cancer Education (GRACE).

Looking Ahead: After Brain Metastases Treatment

After radiation, surgery, or systemic treatment for brain metastases, your doctor will most likely order an MRI to determine how much of the tumor is gone and then continue to follow up every few months with another MRI.

The prognosis for people with NSCLC that’s metastasized to the brain is highly variable, so it’s important to keep in mind that statistics don’t necessarily pertain to your situation. While the outlook was traditionally poor for people with NSCLC and brain metastases, advancements in treatment are continually improving survival rates.

Clinical trials are regularly being conducted to find ways to improve treatment for people with NSCLC that’s metastasized to the brain. Ask your doctor whether you may be a candidate for such a trial. You can also search for a clinical trial in your area at ClinicalTrials.gov.

“Brain metastasis has traditionally been an area that was difficult to study,” Goldman says. “But, thankfully, more and more studies are focused on exactly this problem.”

Additional reporting by Erica Patino.

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