Gamma Knife vs Whole Brain Radiation

dorimak · January 2019

I was devastated today to learn that I have six small brain mets and understand via nurse practitioner (because my MO is out this week) that the recommendation is to set me up for whole brain radiation. I have read a number of articles and waded through the brain mets thread and I am unable to determine how they decide on WBR vs gamma knife. The WBR looks like it comes with significant side effects. Does anyone one know how they make the decision?

AllyBee · January 2019

Generally I think they opt for gamma knife when there is only a few lesions less than a certain size, I think it's up to 3cm but I can't remember. It also depends on the location of the mets. I had one 2cm lesion and was advised to have a crainiotmy rather than gamma knife to confirm pathology and because of the location. I think treatment with gamma knife is becoming more common and their willing to treat more mets with it. I have seen other ladies on here who have insisted on gamma knife rather than WBR, they may be able to provide more information.

illimae · January 2019

Yes, what allybee said. I had 5 lesions less than 1 cm and the tumor board at MDA discussed WBR vs Gamma knife (they prefer gamma for 4 lesions or less.) They ended up recommending gamma, which I found fairly easy and effective. However, WBR may have offered some protection against future lesions, assuming its gets any tiny immeasurable spots too. It worked well but I did have to have gamma again 6 months later for 5 more new spots but I’ve been all good since April.

dorimak · January 2019

Wanted to provide an update in case someone finds this in a search. I have six spots. Largest is 2cm and others are <1 cm. Talked to RO and asked him what my alternative was to WBR. He mentioned gamma and said that while they normally only do for 1-4 mets that things are shifting. He was at a conference recently where some ROs did on many mets like up to 20. In my case he was willing to do SRS (gamma). Two spots are too small to treat so he'll watch them. Of course there is the risk of additional lesions that are not visible on imaging but I personally prefer to take a risk and maximize my quality of life. It's a very individual decision.

illimae · January 2019

Great, I think you'll be pleasantly surprised with gamma and how normal you feel after. The frame is scary but only briefly and you might have some random twinges of nerve like pain in the following weeks but the SE's are usually minimal. I felt good enough to go see a band play the night of my first treatment and did a 5k the week after my 2nd. You got this 😀

dorimak · January 2019

Thanks illimae, it's a relief for me at this point. I forgot to ask the RO what the next steps are after the treatment. I'm sure there may be differences but when did they scan you again to see how it's going, and how often do they scan after that? Sounds like you're doing well..

illimae · January 2019

I was scanned 1 month post gamma (10/2017), with the expected size reductions and no new lesions, the next scan was 2 months later. That repeated until April 2018, when I had 5 new spots and a 2nd gamma knife treatment. Currently, I have 1 stable remnant and nothing new for several months.

dorimak · January 2019

Thank you. Long may you remain stable

dorimak · January 2019

Providing in a update in case someone should come across this thread. I had also scheduled a second opinion with the RO who did my original radiation in 2001. She said she probably would have recommended gamma (Strereotactic) radiation first. She said it's not like they can't do WBR later if needed. I had three treatments over three days. As illimae described, I felt fairly normal after although was really tired and lay down when I got home and slept for three hours. Honestly I think though it was more emotional exhaustion about the anticipation of it. The next two treatments took around 20 minutes and I felt fine afterwards. I'm two days post now and overall feel fine other than the overall anxiety of this new developed. I had quite limited disease just in some nodes under my sternum and a small lesion in a node at my lung so MO felt I had an excellent prognosis. I would love to hear from others who insisted on gamma versus WBR and how they are doing.

Gamma Knife vs Whole Brain Radiation

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