Multiple (15) ASPS brain mets treatment

[Olga]

We have an unique case here when one of our patients had his multiple brain mets treated with the GammaKnife (a subtype of a radiosurgery) and an open brain surgery during the last 3 years - in total, he had 9 Gamma Knife procedures and few neurosurgeries to treat about 15 brain mets since Sept 2012.

http://www.cureasps.org/forum/viewtopic ... 7767#p7767

In their experience, when the irradiation dose was 14 Grays the treatment was incomplete and followed by the local recurrence, but became complete when it was increased to 18 grays, but the recently treated mets were also found on a smaller size that may contribute to their better response. The patient's cognitive condition is good, he is doing very well, exercises and goes to work everyday.
From this case, it appears that even multiple ASPS brain mets could be manageable if found on a smaller size and treated promptly with the appropriate dose/experienced neurosurgeon.
Lynette, what was the smallest size of the brain met successfully targeted and completely treated by the GammaKnife?

[Jorge]

Here is our experience of the brain mets:

2 mets of over 2cm(2~2.5cm): Sept 2012, first treated with Gama Knife, peripheral dosage 17 Grays. They shrunk to 1.X cm. Treated with Gama Knife again 7 months later (Apr 2013) as there was sign of recurrence, dosage 14 Grays. Obvious recurrence in 7 months later (Jan 2014), the biggest one grew to over 3 cm. Had 2 neurosurgeries to remove them as they were located in different location.

1 met of 1.1cm: Apr 2013, treated with Gama Knife, 14 Grays. Showed recurrence in ~7 month, had it resected in the second neurosurgery with the other recurrence mentioned above.

5 mets at size 4mm~8mm: Oct 2013, treated with Gamma Knife, 14 Grays. Stayed at the same size for 6 months. Apr 2014, treated with Gamma Knife again, 14 Grays. The smaller ones <6mm continue to show necrosis and absorbed. The bigger one was treated again with 18 Grays 4 months later (Sept 2014, may be too aggressive) and shows necrosis.

some other mets at size 4mm~8mm: Jun ~ Nov 2014, treated with Gamma Knife, 18 Grays. The smaller ones are disappeared. The bigger ones are still on supervision.

1 met of 1.2cm: Sept 2014, treated with Gamma Knife, 18 Grays. Expands to 3cm with necrosis in 2 months! Shrinkage gradually in the following 2 scans. On supervision.

My conclusion from George's experience:
14 Grays is not enough for ASPS brain mets, even the tumor is in a few millimeters.
18 Grays can destroy the brain mets in size of millimeters. For mets over 10 millimeters, it's not clear if 18 Grays can destroy the tumor completely.
For mets over 15 millimeters, the chance to destroy it with Gama Knife at regular radiation dosage is very slim.
However, Gama Knife can be used as a palliative treatments for bigger mets.
The main side effects of Gama Knife is swelling--very stubborn! Although George's cognitive condition is good, but his vision has been badly hurt due to the stubborn swelling.

I will update on this thread when there is anything special on George's brain MRIs.

[D.ap]

Lynette and Jorge

Thank you soooo much for your information on Jorges treatments.
I hope today finds Jorge feeling well.

My question is how many times were you able to visit with a neurosurgeon and or neurologist in your treatments of the brain tumors?
I don't know if the consultation would in any way of changed your choices as the radiosurgery and or sub radiosurgeries are an excellant treatment to brain surgery and allows a patient to resume their everyday schedules of work aside from the swelling.

Love
Debbie

[arojussi]

I was recently found 20 brain metastases biggest around 2 cm. I start radiation tomorrow.

[Olga]

what is the plan. Do they start from the 20 mm one, can they figure out which one is symptomatic?

[arojussi]

We start with rapid arc radiation for 13 biggest ones. I hope we can later radiate the rest and operate the 2 biggest ones if they dont respond to radiation. And I am on Votrient now and hope to ad Keytruda.