Brain mets - radiation?



J

John Smith

Guest
Just when I thought things couldn't get any worse, they do.

Review: Mom had metastatic breast cancer for 11 years with mets to the bones and Ovarian cancer for
1 year (new primary). She was living alone independently with daily home care until two weeks ago
when she got dizzy, fell and broke her arm. She's anemic, low platlets, and has congestive heart
failure down to 25% function probably from the Herceptin. She elected not to have the surgery and
was psychologically evaluated a week ago Saturday as competent to make that decision. The hospital
she was in was terrible, despite the large sign on the wall, just about every person who came in
would pick up her broken arm and she would scream in pain! My brother and I looked into options and
she wanted to go to a palliative care center that specializes in terminal cancer patients. She was
transferred there last Wednesday. She was fine Wednesday night.

New developments: Something bad happened. Pretty much overnight, she has developed some kind of
dementia. She's very confused. I am devastated. Her doctor said that there could be a number of
causes, like a stroke, or infection, but its most likely brain mets. They will try to treat it with
steroids first and if her response is sufficiently favorable, then they will do a cat scan to see
what's going on. If they elect to go that route, they will have to do the cat scan in another
hospital because the palliative specialty hospital she's in doesn't have the equipment. It is
terribly cold this week in New York. He said that if they determine that its brain mets, then
radiation may shrink the mets and prolong her life from 3-6 months, possibly even restoring her
mental function. Although she did improve a litte from the steroids, she was able to ask for milk
and apple sauce, she reconized me, my brother, and a picture of her mother, she was able to say she
was hot, from what he's seen of her, the doctor does not think its sufficient to warrant any further
action. He thinks that if she doesn't respond sufficiently to the steroids, there is little hope for
a response from radiation, and moving her to do the cat scan would be traumatic.

My question is why don't they just assume that its brain mets give her the radiation anyway and see
what happens. Why bother with the expensive cat scan. I didn't think radiation was that expensive.
Isn't it possible that she will respond to radiation when she doesn't respond to steroids?

I know I'm going to lose her, and she's being kept extremely comfortable, and she couldn't be in
better more caring nursing hands. But there is no amount I wouldn't give for just one more
intelligent conversation. I don't know if I should force the issue possibly by moving her again. I
don't know if that would be doing her a favor or should I just let her go.
 
M

Madiba

Guest
John Smith <[email protected]> wrote:

> My question is why don't they just assume that its brain mets give her the radiation anyway and
> see what happens. Why bother with the expensive cat scan. I didn't think radiation was that
> expensive. Isn't it possible that she will respond to radiation when she doesn't respond to
> steroids?
She could be (theoretically) be responding to brain edema without mets so if they went ahead and
irradiated that the rad oncs would be in hot water, esp. in the litigious USA..

--
madiba
 
S

Steph

Guest
"John Smith" <[email protected]> wrote in message
news:[email protected]...
> Just when I thought things couldn't get any worse, they do.
>
> Review: Mom had metastatic breast cancer for 11 years with mets to the bones and Ovarian cancer
> for 1 year (new primary). She was living alone independently with daily home care until two weeks
> ago when she got dizzy, fell and broke her arm. She's anemic, low platlets, and has congestive
> heart failure down to 25% function probably from the Herceptin. She elected not to have the
> surgery and was psychologically evaluated a week ago Saturday as competent to make that decision.
> The hospital she was in was terrible, despite the large sign on the wall, just about every person
> who came in would pick up her broken arm and she would scream in pain! My brother and I looked
> into options and she wanted to go to a palliative care center that specializes in terminal cancer
> patients. She was transferred there last Wednesday. She was fine Wednesday night.
>
> New developments: Something bad happened. Pretty much overnight, she has developed some kind of
> dementia. She's very confused. I am devastated. Her doctor said that there could be a number of
> causes, like a stroke, or infection, but its most likely brain mets. They will try to treat it
> with steroids first and if her response is sufficiently favorable, then they will do a cat scan to
> see what's going on. If they elect to go that route, they will have to do the cat scan in another
> hospital because the palliative specialty hospital she's in doesn't have the equipment. It is
> terribly cold this week in New York. He said that if they determine that its brain mets, then
> radiation may shrink the mets and prolong her life from 3-6 months, possibly even restoring her
> mental function. Although she did improve a litte from the steroids, she was able to ask for milk
> and apple sauce, she reconized me, my brother, and a picture of her mother, she was able to say
> she was hot, from what he's seen of her, the doctor does not think its sufficient to warrant any
> further action. He thinks that if she doesn't respond sufficiently to the steroids, there is
> little hope for a response from radiation, and moving her to do the cat scan would be traumatic.
>
> My question is why don't they just assume that its brain mets give her the radiation anyway and
> see what happens. Why bother with the expensive cat scan. I didn't think radiation was that
> expensive. Isn't it possible that she will respond to radiation when she doesn't respond to
> steroids?
>
> I know I'm going to lose her, and she's being kept extremely comfortable, and she couldn't be in
> better more caring nursing hands. But there is no amount I wouldn't give for just one more
> intelligent conversation. I don't know if I should force the issue possibly by moving her again. I
> don't know if that would be doing her a favor or should I just let her go.

Radiation has no impact on survival. It may improve symptoms in someone who is in good general
condition. Someone who is bed-bound or very sick is very unlikely to benefit from radiotherapy.