Please remember that this is general information and is meant as a guide. All diagnoses and treatment options should be discussed in full with a qualified clinician.
Any malignant tumour may metastasise (spread) to the brain. Malignant melanoma shows the highest frequency, with other sites of common origin being bronchus, breast, kidney, thyroid, stomach, prostate and testis. Many such patients with spread to the brain will have more than one metastasis.
Patients can present with epilepsy, but symptoms occurring from local brain damage or raised pressure inside the head are also common. These symptoms can include:
Steroids often have a dramatic and rapid effect, producing clinical improvement in many patients. However, they do not destroy the lesion. Steroids are often given in conjunction with surgery, radiotherapy or gamma knife.
Aggressive treatment options, such as surgery and gamma knife, are usually reserved for patients who have just a single brain lesion, have their primary malignancy well-controlled and have no further disease elsewhere in the body. For solitary lesions that lie in an accessible site, complete excision provides good results. It has been suggested that results may be improved further when surgery is followed by radiotherapy and/or gamma knife. For patients with 1-3 small brain metastases, and whose systemic cancer is under control, gamma knife alone is an option. Gamma knife can be used to treat more than one lesion at a time and can be repeated if necessary.
In patients with multiple lesions, surgery is seldom practical or even possible. The current policy of The London Gamma Knife Centre is normally whole brain radiotherapy for all patients with multiple brain metastases. If such treatment fails to control one or two lesions in a patient whose systemic disease remains otherwise well-controlled, and with good performance status, then gamma knife treatment can be used selectively as a boost therapy. This treatment regime may also be considered suitable when one brain metastasis is disproportionately larger and/or more critically situated than any other. Where this is not the case, whole brain radiotherapy can be given alone and provides helpful palliation for many patients.