Expert: Claes-Gustaf Nordquist, M.D. - 8/14/2008

Question
Hi My Dad was DX in April of this year with MRCC mets to lungs. Two weeks ago he fell and could not use his left side. Went to Er and found brain mets that was bleeding. Was in ICU for 8 days. the started WBRT the next day. I was wondering why they did not use Gamm knife or surgury. Is he to far gone to use other options? His tumor was 4mm on right lobe.  How much time do you think we have left? Straight anwsers. This must be for pailliative care only if they are not being aggressive right?

Answer
A 4 mm tumor in his brain is indeed small enough to be treated with the GammaKnife. However since his cancer had already spread to his lungs before that he was a stage 4 cancer case even before this brain lesion was found. If his cancer has spread to somewhere (and here it has spread to at least 2 different places) it has probably also spread to elsewhere even if not detected - perhaps not even detectable - yet. It is therefore probable that he may have other not yet detected lesions in his brain and elsewhere. If it has spread to his lungs as here it is not uncommon for it to spread to the brain from there as here. That makes it very improbable that a GammaKnife treatment - if available - could give any more permanent relief and a cure is unfortunately with both lung and brain lesions at present impossible. Since conventional radiation therapy can in this case at best only give some temporary relief I would personally have preferred to use the GammaKnife but even with that method in this sad situation his relief would be temporary for the reasons I have described so there would unfortunately not be any real gain. So unfortunately what he is given is palliative care only as that is the only possible option here. Chemo therapy may also be an option. But that would be a temporary one too unfortunately. Survival times can not be predicted with any precision but in this situation I regard it as probable to be from a few weeks to a few months only unfortunately. I'm sorry I have nothing better to tell you!