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Pappas Center @ MGH
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IMPROVING THE ODDS - Expanding Options for Advanced Disease

The most common cancers in the brain are those that spread (metastasize) from a primary tumor elsewhere in the body. Because of the complex needs of people with metastatic brain cancer, the Steven E. and Catherine Pappas Center for Neuro-Oncology established the Metastatic Disease Program, led by neuro-oncologist April Eichler, MD. Working in collaboration with radiation oncologist Helen Shih, MD, and neurosurgeon Bob Carter, MD, PhD, Eichler offers patients a variety of therapeutic options including radiation, chemotherapy and surgery. The multidisciplinary clinic also provides coordinated care for the neurological symptoms caused by brain metastases..
Traditionally, patients with brain metastases have been cared for by their medical oncologist,” says Eichler. “But many of these patients develop neurological complications such as seizures, brain swelling, and cognitive impairments that a neurooncologist has the additional expertise to deal with.”
Determining the best treatment depends on many factors. “We take into account all aspects of the disease including how active it is outside the brain,” says Eichler. One state-of-the-art treatment is stereotactic radiosurgery (SRS), a radiation therapy (not surgery) that uses several converging beams to concentrate a large dose of radiation on a solitary site. Sometimes given following whole-brain radiation, SRS is a common treatment for patients with a limited number of newly diagnosed brain tumors less than four centimeters in diameter (smaller than a golf ball).
April Eichler, MD
Expanding treatment options for patients with metastatic disease is a major goal of the program, which officially opened in January 2007. Eichler explains that patients with lung cancer, for example, who might otherwise be eligible for a clinical trial, are often excluded if they have brain metastases. As a result, “there’s a lack of data on which chemotherapies might be useful for these patients. Our clinic is a step toward identifying and recruiting patients so that we can get trials up and running.”
Two trials are slated to open over the next few months. One will study epothilone B, a new class of drug, in patients with non-small cell lung cancer whose brain metastases have recurred following radiation. The other will investigate the same drug in breast cancer patients with brain metastases.
When a primary tumor has spread to the brain, the disease is already advanced, says Eichler, and survival is generally poor. “But we all have patients who are beating the odds.” She tells of one woman with breast cancer who developed a tumor in her pituitary (a gland at the base of the brain). Shih treated her successfully with SRS and then Eichler followed up with a specialized treatment called intrathecal (into the spinal canal) chemotherapy, clearing the patient’s spinal fluid of cancer cells. “She’s someone we treated in a multidisciplinary way and who is continuing to do well.” - Lonnie Christiansen
Advancing the Specialized Care of Individuals with Brain Tumors
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