We created our Brain Metastases Program specifically to meet the treatment and follow-up needs of patients who have brain cancer that has spread from another part of the body (such as a breast or a lung) to the brain. It is a complement to our Brain and Spine Tumor Program where we treat patients who have tumors that started in the brain or spine.
How common are brain metastases?
Many cancers have the potential to spread to the brain — an occurrence called brain metastasis. Brain metastasis is relatively common, affecting between 20% and 40% of all cancer patients. It is 10 times more common than brain cancer that starts in the brain. Some cancers like lung, breast, kidney and colon cancers, as well as melanoma, are more likely to spread to the brain than other cancers.
What are the signs of brain metastasis?
Symptoms of brain metastasis can include vomiting, frequent headaches, seizures and changes in personality that you or those close to you may notice.
Complex Treatment Needs and Growing Survival Rates
Medical decision-making for treating brain metastases is becoming more complex. Sophisticated treatments are helping extend survival with patients living longer with brain metastases than in the past. Although it is not typical, our specialists treat some patients who have the potential to be cured. Living longer with brain metastasis demands the ability to live with good brain function.
Treatment for brain metastasis requires highly specialized experts who consider a patient’s many health variables to help form the most effective treatment recommendations.
Nuanced Care Requires Special Expertise
Traditionally, brain metastases were handled by the same team that treated the patient’s original cancer. The part of the body where the cancer started is known as the primary disease site. For example, a breast cancer team would retain oversight and care for the breast cancer patient who developed brain metastasis. Historically, this approach presented challenges, as brain disease management has many nuances that are critical to the understanding of optimal treatment.
Our brain metastasis-focused team has the specialty expertise to address medical decision nuances, enroll patients in clinical trials and help mitigate side effects that can affect cognition — the mental process of gaining knowledge and understanding through thoughts, experience and the senses. The Brain Metastases Program acts as a bridge and complements the care provided by the primary disease site team.
Treatment can involve brain surgery to remove the tumor or reduce its size and relieve symptoms without disrupting brain function. There are also options in radiation therapy to stop or slow tumor growth. These include Gamma Knife® Icon™ (incisionless, focused radiosurgery), Elekta Unity MR-linac (image-guided adaptive radiation therapy), and whole brain radiation therapy that avoids the hippocampus (primarily associated with memory). Whole brain radiation therapy may be appropriate if there are multiple tumors. Medical options include targeted systemic therapy, therapies directed toward specific genetic mutations, and for some patients, immunotherapies to eliminate tumors and stop their spread. Immunotherapies, which harness the body’s immune system to fight cancer, are especially suited to treating brain metastases from melanoma, but are still being studied for treating other types of brain metastases.
Our brain metastasis specialists manage the care of local and distant patients together with the patient’s own doctors. Together, they determine if the patient’s own doctor can provide the treatment or if they need specialized treatment at Froedtert Hospital.
Specialized Expertise for Brain Metastases
Our Brain Metastases Program includes doctors from neuro-oncology, radiation oncology, medical oncology, neurosurgery, neuropsychiatry, neuroradiology and neuropathology — all of whom help plan treatment and monitor patients for treatment effectiveness, tumor growth and quality of life changes. A neuropsychiatrist is an integral part of the decision team to make sure the patient retains cognitive function through treatment and beyond.
These experts meet once each week in a meeting called a tumor board, where they review patient cases and design treatment plans that will be the most effective for each person. Specialists who treat primary cancers (the cancer originally diagnosed) are part of this group because while they are experts in their respective fields of cancer, they rely on brain metastasis specialists when the primary cancer spreads to the brain. By consulting with physicians in our Brain Metastasis Program, cancer doctors can expand options to extend their patients’ survival and quality of life.
Brain Metastasis Can Need Urgent Treatment
While brain metastasis does not always need urgent treatment, for some patients, immediate treatment is critical. The person who just received the brain metastasis diagnosis considers a brain metastasis an urgent problem. Their primary cancer medical team may have similar concerns due to unfamiliarity with treating metastatic disease.
App Expedites Treatment: Recommendations in Hours, Not Days
The brain metastasis tumor board is an efficient and effective treatment-planning tool. However, patients who need urgent treatment cannot wait a week for the tumor board to convene and offer recommendations. Recognizing this need, radiation oncologists and others within the Froedtert & MCW Cancer Network developed a protocol grid to guide treatment for every type of brain metastasis. It included multiple individual variables — the type of primary cancer and its pathology, the number and size of brain tumors and the patient’s overall health status. All of these factors determine the required care paths.
They piloted the protocol with brain metastasis patients in the hospital and found it could reduce a patient’s hospital stay from seven or eight days to about three. This approach not only allowed faster treatment, it offered the potential for cost-savings by reducing hospital stay.
The protocol grid’s intense complexity made it an ideal candidate for developing an app we call the Network for Integrated Management of Brain Metastasis Linking Experts, or NIMBLE. The app is essentially a virtual tumor board connecting cancer doctors with brain metastasis specialists who provide treatment recommendations in hours, not days.