Treatment

Treatment for brain metastases can help ease symptoms, slow tumor growth and extend life. Even with successful treatment, brain metastases often recur, so your doctor will recommend close follow-up after treatment.

Treatment options for people with brain metastases often include medication, surgery, stereotactic radiosurgery, whole-brain radiation therapy or some combination of these. In certain situations, your treatment team may consider drug treatments for brain metastases.

What treatments are best for you will depend on the type, size, number and location of the tumors, as well as your signs and symptoms, overall health, and preferences. Talk with your doctor about your goals for treatment.

Medications to control symptoms

Medications can help control signs and symptoms of brain metastases and make you more comfortable. Options might include:

• Steroid drugs. High-dose corticosteroids may be used to ease swelling around the brain metastases in order to reduce signs and symptoms.
• Anti-seizure drugs. If you experience a seizure, your doctor may recommend medicine to prevent additional seizures.

Surgery

If surgery is an option for you and your brain metastases are located in places that make them accessible for an operation, your surgeon will work to remove as much of the cancer as possible. Even removing a portion of the tumor may help reduce your signs and symptoms.

Surgery to remove brain metastases carries risks, such as neurologic deficits, infection and bleeding. Other risks may depend on the part of your brain where your tumors are located.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays and protons, to kill tumor cells. For brain metastases, your treatment may involve one or both of the following radiation therapy methods:

• Whole-brain radiation. Whole-brain radiation applies radiation to the entire brain in order to kill tumor cells. People undergoing whole-brain radiation usually require 10 to 15 treatments over two to three weeks.

  Side effects may include fatigue, nausea and hair loss. Long-term, whole-brain radiation is associated with cognitive decline.

• Stereotactic radiosurgery. With stereotactic radiosurgery (SRS), each beam of radiation isn't particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells. SRS is typically done in one treatment, and doctors can treat multiple tumors in one session.

  Side effects may include nausea, headache, seizures, and dizziness or vertigo. The risk of long-term cognitive decline after SRS is thought to be less than that with whole-brain radiation.

In recent years, doctors and researchers have made significant advances in their understanding of whole-brain radiation, stereotactic radiosurgery and how these two methods affect people's survival, cognitive ability and quality of life. In deciding which type of radiation therapy to use, you and your doctor will consider many factors, including what other treatments you're undergoing and the potential for you to experience cancer recurrences after treatment.

Medications

In certain situations your treatment team might recommend medications to control your brain metastases. Whether medications might help you will depend on where your cancer began and your individual situation. Options might include:

• Chemotherapy. Chemotherapy uses drugs to kill quickly growing cells in the body, including cancer cells.
• Targeted therapy drugs. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
• Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Rehabilitation after treatment

Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Your doctor may refer you to services that can help:

• Physical therapy can help you regain lost motor skills or muscle strength.
• Occupational therapy can help you get back to your normal daily activities, including work, after a brain tumor or other illness.
• Speech therapy with specialists in speech difficulties (speech pathologists) can help if you have difficulty speaking.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your doctors to provide an extra layer of support that complements your other treatments.

Palliative care is provided by a team of specialists in medicine, psychology, spiritual care and social work. This team works to help improve the quality of life for people with cancer and their families.