Brain Metastasis Clinical Trial

BRAIN METASTASIS

Brain metastases are the most common brain tumors and are seen in 10-30% of all cancer patients. They occur when cancer cells from the primary tumor break away, enter the bloodstream, and reach the brain where they start to grow.

Many types of cancers can spread to the brain. The most common cancers to lead to brain metastases include:

Brain Met Scan1• Lung cancer
• Breast cancer
• Kidney cancer (renal cell cancer)
• Colon cancer
• Rectal cancer
• Melanoma (a type of skin cancer)

SYMPTOMS

Some patients with brain metastases have symptoms; others are symptom-free but have metastases discovered with MRI or CT scans. Some of the symptoms that may be caused by brain metastases are:

• Headache
• Focal neurologic deficit, such as a loss of movement or sensation
• Cognitive dysfunction, such as memory problems and mood or personality changes
• Stroke
• Seizures

To find out about the clinical trial, please click here.

TREATMENT OPTIONS

Surgery. Surgery provides rapid relief of symptoms and may be recommended for large, symptom-causing tumors in patients who are able to have surgery. Even if all of the tumor is removed with surgery, there is still a high risk of tumor coming back (recurrence). Therefore, radiation therapy, either whole brain radiation or stereotactic radiosurgery, is recommended following surgery for all patients.

Whole brain radiotherapy. As the name implies, whole brain radiotherapy treats the entire brain with radiation. Whole brain radiation typically requires 10 to 20 daily treatments (Monday through Friday). Whole brain radiation may be given alone or as a combination with surgery or stereotactic radiosurgery.

• Advantage of whole brain radiation: Whole brain radiation treats the entire brain. Therefore, in addition to treating metastases that are big enough to be seen on MRI scans, it also kills tumor cells of metastases that are too small to be detected with MRI scans.

• Disadvantage of whole brain radiation: Whole brain radiation cannot discriminate between metastases and normal brain; the entire brain receives the same dose of radiation, whether it be cancer or normal brain. Therefore, with whole brain radiation, there is a risk of late side effects, including problems with memory and cognition.

Stereotactic radiosurgery. Focused, high dose radiation is directed to kill cancer cells within targeted brain metastases in 1 to 5 treatments. The surrounding normal brain receives very little dose of radiation.

• Advantage of radiosurgery: In radiosurgery, radiation is targeted precisely at the tumor, while minimizing the radiation dose to the rest the brain. Therefore, unlike whole brain radiation, late side effects, such as difficulties with memory and cognition, are minimized. In addition, some tumor types, such as kidney cancer (renal cell cancer) and melanoma, are thought to have better response with radiosurgery compared to whole brain radiation.

• Disadvantage of radiosurgery: Radiosurgery can only treat tumors that are large enough to be seen on MRI or CT scan. Tiny tumors that are too small to be seen with MRI scans cannot be treated. Therefore, patients need to be monitored closely for signs of tumor growth elsewhere in the brain. If new tumors are detected elsewhere, additional treatment (either repeat radiosurgery or whole brain radiation) may be recommended. Radiosurgery can lead to radiation-associated brain swelling (edema) in a small group of patients.

Supportive Care/Symptom management. Medications are used to manage symptoms caused by brain metastases. For example, corticosteroids can help relieve swelling (edema) caused by the tumor.

WHAT IS THE RIGHT TREATMENT FOR ME?

The most appropriate treatment for each individual patient depends on a number of factors, including the number of brain metastases, patient preference, and the overall health of the patient. Therefore, an in-depth discussion with your doctor is recommended.

CYBERKNIFE STEREOTACTIC RADIOSURGERY TREATMENT OF BRAIN METASTASES AT STANFORD

Brain Met Scans

Precisely targeted radiation is delivered to brain metastases using a completely non-invasive, painless out-patient procedure. There is no need for local or general anesthesia. Unlike frame-based stereotactic radiosurgery systems that require a head frame to be bolted onto the patient’s skull using aluminum or titanium screws, no head frame is needed with CyberKnife radiosurgery.

CLINICAL TRIALS AVAILABLE ONLY AT STANFORD:

Clinical Trial 1: Multi-Session Radiosurgery for Large Brain Metastasis

Currently available treatments, such as whole brain radiation or single fraction stereotactic radiosurgery, DO NOT adequately treat large brain metastases; many such patients experience tumor recurrence. Our goal is to provide better treatments for our patients with large brain metastases.

Brain Met Scan 3

It has long been established that fractionation (i.e., dividing the treatment over multiple treatment sessions) increases tumor kill and decreases late side effects. Prior to the advances in radiosurgery technology, fractionated radiosurgery was not feasible because of the inconvenience and patient discomfort associated with repeated placement of the head frame. Because there is no need for a head-frame, fractionated radiosurgery can easily and painless be achieved with CyberKnife radiosurgery.

Our clinical trial is investigating if dividing the treatment over multiple sessions may improve tumor control while reducing the late side effects of radiation.

What is involved in this study?

The goal of this study is the find the optimal radiation dose to deliver when treating large brain metastases. Eligible patients will be evaluated by the doctors at Stanford. Patients who are likely to benefit from surgery will have surgery first followed by radiosurgery. Patients that are not likely to benefit from surgery will have radiosurgery.

Patients will be treated over multiple treatment sessions, typically completing therapy within a week. Following radiosurgery, patients will be followed closely with follow-up clinic visits and brain MRI scans.

Am I eligible for this study?

This study is open to all patients age 18 years and older with large brain metastases (i.e., brain metastases measuring 2-4 cm in diameter, or 2.4-33.5 cm3 in volume).

To be eligible, patients must be:

• Age 18 years and older
• Have 1 to 4 brain metastases
• All brain metastasis must measure less than 2 cm in diameter (or less than 4.2 cm3 in volume)
• Prior surgery or SRS is allowed as long as the target metastatic lesion in this study has not previously been treated with SRS
• Patient must exhibit the ability to understand and the willingness to sign a written informed consent

To learn more about this study, please see contact information below

Clinical Trial 2: A Novel Drug to Enhance Stereotactic Radiosurgery - Treatment of Brain Metastasis from Lung Cancer

Histone deacetylase (HDAC) inhibitors are a novel class of cancer drugs that kills or stops the growth of cancer cells.  Investigators at Stanford developed a clinical study in which a HDAC inhibitor will be used with stereotactic radiosurgery to treat brain metastases in patients with non-small cell lung cancer. 

What is involved in this study?

Potential patients will be evaluated by the doctors at Stanford.  Patients who enroll in the study will be treated with a single session radiosurgery and a HDAC inhibitor drug.  Patients will take the pill by mouth, once per day, for a total of 14 days.  Following radiosurgery, patients will be followed closely with follow-up clinic visits and brain MRI scans.

Am I eligible for this study?

To be eligible, patients must be:

• Age 18 years and older
• Have 1 to 4 brain metastases
• All brain metastasis must measure less than 2 cm in diameter (or less than 4.2 cm3 in volume)
• Prior surgery or SRS is allowed as long as the target metastatic lesion in this study has not previously been treated with SRS
• Patient must exhibit the ability to understand and the willingness to sign a written informed consent

To learn more about this study, please see contact information below

CONTACT INFORMATON FOR CLINICAL TRIAL

For more information, or to learn how to participate in a clinical trial for brain metastases, please contact our clinical trials coordinator:

Jacob Wynne
Clinical Research Assistant
Department of Radiation Oncology, Stanford University 
jwynne@stanford.edu
(Tel) 650-723-8843

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