Diagnosis and Treatment Options for Brain Metastase
Tests for Brain Metastases
Several types of brain scans can be used to diagnose melanoma brain metastases, including CT scans, MRI, or PET scans.Learn more about imaging studies
Symptoms to Watch Out For
Specific neurologic signs and symptoms might indicate brain metastases. These include headache, muscle weakness, and behavioral changes such as changes in judgment and reasoning. Physical problems can include vision changes, hearing loss, dizziness, nausea or vomiting, language disturbances, difficulty walking, and seizures.
If you have been diagnosed with melanoma and have any of these symptoms, you should contact your medical oncologist as soon as possible.
Treatments Options for Melanoma Brain Metastases
Currently, treatment options for brain metastases depend on the number of metastases, their size and location, the presence of extracranial metastases (melanoma outside of the brain and spinal cord), and the performance status of the patient.
- Well-established and a standard treatment for melanoma brain metastases. This treatment is potentially curative.
- Usually reserved for patients with less than 3 brain metastases. Patients with many tumors or tumors in critical areas of the brain are usually not candidates for surgery.
- SRS (stereotactic radiosurgery) focuses on certain spots in the brain. One newer type, gamma knife, is able to treat metastases more quickly than previous radiation machines. SRS can result in long-term control of brain metastases for some patients.
- An alternative to surgery for patients with less than 3 brain metastases. At some centers, gamma is used to treat more than 3 brain metastases.
- WBXRT (whole-brain radiation treatment) treats brain metastases that can be seen as well as tumor cells that are too small to be identified by MRI or CT scans. WBXRT is likely to slow the growth of tumors, but it is generally not thought to be curative.
- Typically used in patients who have too many brain metastases to be suitable for surgery or SRS
- Drugs such as fotemustine and temozolomide are able to get into the brain tissue and may be used to treat patients with brain metastases.
- While these therapies may provide dramatic responses in some patients, they can only slow the growth of tumors in the brain; they are not curative. The majority of tumors will eventually start to grow again.
- Most standard chemotherapy drugs cannot penetrate the blood-brain-barrier and therefore have no effect on brain tumors.
- For most patients with BRAF V600 mutations, certain BRAF inhibitors (for example, dabrafenib and vemurafenib) can cause, significant shrinkage of brain metastases. These BRAF inhibitors are usually not curative, although, they can slow tumor growth.
- In a phase II clinical trial of Tafinlar in patients with a BRAF V600E mutation, 18% of the patients showed a shrinkage in their brain metastases.
- Immunotherapies (for example, ipilimumab) can sometimes result in the shrinkage of brain metastases. Initial data from clinical trials suggests that in some patients the control of the brain metastases can be durable (> 2 years).
- The existing data suggests that ipilimumab has the greatest chance of producing clinical benefit when brain metastases are relatively small and patients do not require steroids to controls symptoms. Additional trials with other immunotherapies will be needed to test/define their appropriate use.
- Designed to reduce pain, confusion, and/or seizures but not intended to slow or eliminate the growth of the tumors. Steroids (ie dexamethasone) are frequently used to reduce swelling in the brain caused by metastases, which may help ease symptoms of pain and confusion.
- Often used when the physician feels that active treatment will do more harm than good, or it is the patients’ preference not to be treated.