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Innovations in the Treatment
of Brain Metastases


Treatment for brain metastases was once limited to whole-brain radiotherapy. With new options like the Novalis® tx™ stereotactic radiosurgery available at Cancer Center of Santa Barbara, physicians can now achieve better outcomes—which is excellent news for the estimated 170,000 Americans diagnosed with brain metastases every year.


According to George Cheng, MD, PhD, radiation oncologist with Cancer Center of Santa Barbara,  approximately 20 to 40 percent of patients with cancer will develop brain metastases. Although brain metastases most commonly develop from lung cancer, they also can originate from melanomas or tumor sites in the breasts, kidneys or colon.


“Brain metastases are the most common intracranial tumors in adults, with a ten-fold higher incidence than primary brain tumors,” says Dr. Cheng. “However, the condition may become less common as the efficacy of systemic therapies improves.”


When brain metastases are detected, patients without a previous cancer diagnosis may require a biopsy of the brain lesion to rule out other malignant and non-malignant etiologies. A treatment plan will be tailored to meet each patient’s individual needs based on factors that can include age; overall health and performance; the extent of systemic disease; and the number, size and location of the tumors.


“For patients diagnosed with brain metastases, a referral to a specialized facility such as the Cancer Center of Santa Barbara should be considered to utilize the latest diagnostic and therapeutic technologies and expertise in medical oncology, neurosurgery and radiation oncology,” says Dr. Cheng. “Because the selection of treatment strategy can be multifactorial, a multidisciplinary approach is important.”


Advanced Treatment Options

For the majority of patients with brain metastases, radiotherapy in some form is a large part of effective treatment.


“In a case of single metastasis, the treatment plan may include surgical resection followed by whole-brain radiotherapy—or whole-brain radiotherapy

A coronal view of a computer-generated treatment plan shows the radiotherapeutic dose distribution for radiosurgical treatment of a patient with a left parietal brain metastasis. The high dose region conform tightly to the tumor volume (purple).

This sagittal view of the plan shows the tightly conformal radiation dose distribution around the tumor.


This is an axial view of the computed radiation dose distribution for this plan. This sagittal view of the plan shows the tightly conformal radiation dose distribution around the tumor.

followed by radiosurgery to the individual lesions to ‘boost’ tumor control,” says Dr. Cheng. “Alternatively, stereotactic radiosurgery alone may be recommended when the risk of occult intracranial metastases is relatively low. The Novalis Tx system can sculpt the radiation dose to conform tightly to the shape of the tumor volume and avoid neighboring brain tissue and other critical structures.


"For patients with two to three metastases, whole-brain radiotherapy is usually followed by consideration of radiosurgical boost. Patients with more than two to three metastases are typically treated with whole-brain radiotherapy alone.”


Stereotactic radiosurgery benefits patients diagnosed with brain metastases by delivering


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highly targeted and controlled doses of radiation. The Novalis® Tx™ is a platform for frameless, non- invasive, image-guided radiosurgery using a linear accelerator that rotates around the patient for optimal positioning. This technology can be used to destroy sensitively situated tumors that typically cannot be addressed by conventional surgery.


For some patients, systemic therapy such as chemotherapy may be required due to concurrent extracranial disease progression.


For more information about Cancer Center of Santa Barbara or to refer a patient, call (805) 682-7300