Expert: Claes-Gustaf Nordquist, M.D. - 8/23/2008

Question
My brother (just turned 49) was diagnosed with lung cancer over a year ago, at the time there were no indications of cancer anywhere else.  He went thru several rounds of chemo and radiation with great success.  The tumors were all gone with the exception of one small spot.  They were to continue with treatments with a drug called Avastin for a few months and then do another PET scan.  He was feeling great. Lots of energy and able to go about his life as he choose.  I might add that he never did quit work or completely stop his extra activities even during the initial rounds of treatment.  He felt bad at times but never was so sick that he had to become bed ridden.
But just last week he started loosing mental clarity, unable to focus and do his job.  Was having trouble remembering, even simple things, and become very disoriented.  He recognized that things weren't quite right and went to see his Dr.  They immediately hospitalized him and did a MRI.  They found two brain tumors, one large and one small.  They did surgery to remove the large one from above his left ear, but decided to treat the small on that is behind his right ear with radiation.  We're weren't given a very good prognosis from the initial diagnosis of lung cancer, even with treatment - only 12-24 months.  I guess we developed false hope when the initial treatment did so well, and he was feeling as good as he was.  With these new developments, are we looking at an even shorter time frame of survival?  Is there any possibility that he will be able to get through this as easily as he did the first round of treatment?  How much time does he have left ?

Answer
Unfortunately it is very common that lung cancers spread to the brain. Yes he seemed to get well but so far lung cancers have about the same bad prognosis as they always have had. So unfortunately those hopes were too optimistic. His present tumors can be treated with surgery and radiation therapy and perhaps even with concentrated radiation (GammaKnife or CyberKnife). Even so his prognosis remains bad and even with therapy I expect his survival time in this situation to be around 1 year unfortunately. I'm sorry I have nothing better to tell you!