Diagnosis and Treatment Options 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 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.
Your doctor will discuss a treatment plan with you. The treatment options for brain metastases are determined by 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.
- A standard treatment for melanoma brain metastases and is potentially curative
- Usually reserved for patients with 3 or fewer brain metastases; patients with many tumors or tumors in critical areas of the brain are usually not candidates for surgery
- SRS (stereotactic radiosurgery) targets 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
- In the past, reserved for patients with 3 or fewer brain metastases; at some centers, gamma is now being used to treat multiple 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
- May also be used after surgery to reduce the risk of brain metastases occurring again
- For most patients with a BRAF mutation, BRAF inhibitors (Zelboraf and Tafinlar) 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 mutation, up to 40% of patients showed significant shrinkage of their brain metastases
- Initial data from clinical trials of Yervoy suggests that in some patients the control of the brain metastases can be durable (> 2 years). The data also suggests that Yervoy has the greatest chance of benefiting patients when the brain metastases are relatively small and patients do not require steroids.
- Clinical trials are also ongoing to evaluate the safety and effectiveness of anti-PD1 drugs (Keytruda and Opdivo) in patients with brain metastases. Preliminary results suggests that these treatments can shrink brain tumors
- Drugs such as Temodar and Fotemustine 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
- Often used when the physician feels that active treatment will do more harm than good, or it is the patient’s preference not to be treated
- Intended to reduce pain, confusion, and/or seizures but not to slow or eliminate the growth of the tumors
- Steroids are frequently used to reduce swelling in the brain caused by metastases, which may help ease symptoms of pain and confusion
- Drugs may also be used to control seizures, which can be caused by brain metastases