Monday, March 20, 2017

Surprise, surprise, surprise! The sooner brain mets are found - the better folks with melanoma, breast cancer,!!!

Do you ever read a statistical study that involves bunches of patients, expert researchers, thousands of samples, statisticians and probably a significant chunk of change and think, "No shit, Sherlock!!!"? It happens to me all the time! ~ Just out!  New expert findings regarding obesity in children!  In this new research, utilizing multiple offices and institutions, patient and parental questionnaires, cox 2 data analysis, and all sorts of other jabber, jabber - We have found that obese children are more sedentary and consume more calories than their thinner peers!!!"

In that vein...there is this...

Toward the complete control of brain metastases using surveillance screening and stereotactic radiosurgery. Wolf, Kvint, Chachoua, Pavlick, et al. J Neurosurg. 2017 Feb 17.

The incidence of brain metastases is increasing with improved systemic therapies, many of which have a limited impact on intracranial disease. Stereotactic radiosurgery (SRS) is a first-line management option for brain metastases. The purpose of this study was to determine if there is a threshold tumor size below which local control (LC) rates approach 100%, and to relate these findings to the use of routine surveillance brain imaging.
From a prospective registry, 200 patients with 1237 brain metastases were identified who underwent SRS between December 2012 and May 2015. The median imaging follow-up duration was 7.9 months, and the median margin dose was 18 Gy. The maximal diameter and volume of tumors were measured. Histological analysis included 96 patients with non-small cell lung cancers (NSCLCs), 40 with melanoma, 35 with breast cancer, and 29 with other histologies.
Almost 50% of brain metastases were NSCLCs and commonly measured less than 6 mm in maximal diameter or 70 mm3 in volume. Thirty-three of 1237 tumors had local progression at a median of 8.8 months. The 1- and 2-year actuarial LC rates were 97% and 93%, respectively. LC of 100% was achieved for all intracranial metastases less than 100 mm3 in volume or 6 mm in diameter. Patients whose tumors at first SRS were less than 10 mm maximal diameter or a volume of 250 mm3 had improved overall survival.  
SRS can achieve LC rates approaching 100% for subcentimeter metastases. The earlier initial detection and prompt treatment of small intracranial metastases may prevent the development of neurological symptoms and the need for resection, and improve overall survival. To identify tumors when they are small, routine surveillance brain imaging should be considered as part of the standard of care for lung, breast, and melanoma metastases.
#1.  Well, duh.  If you find brain tumors when they are small and zap them out of existence, patients do not suffer as much damage and live longer.
#2.  I don't I agree with the opening salvo:  "The incidence of brain metastases is increasing with improved systemic therapies, many of which have a limited impact on intracranial disease."  At least in the sense that, as melanoma patients live longer, DUE to systemic therapies....we are seeing more of everything...cause these peeps are not dead!  Also, I fear that since we have learned that we can zap many, many brain tumors sequentially or simultaneously with SRS and melanoma patients actually respond positively as they did NOT when only whole brain radiation was offered or utilized, I fear that some docs are not being as aggressive as they should be in finding a systemic therapy that actually DOES work for the patient who is having brain met after brain met!!!
(Here's a recent post that supports my disbelief!!! - SRS with any systemic therapy helps response in melanoma brain mets...)
#3.  Instead of using this data as a published study to pad your researcher dear researchers!!!....use it to get insurance companies in line with paying for melanoma patients' brain imaging...instead of telling ANY melanoma patient, much less one status post BRAIN TUMORS - 
"You may experience the pleasure of your CT scans as planned, however in regard to the MRI...."Based on eviCore Oncology Imaging Guidelines, we are unable to approve the study your doctor requested.  Your records show that you have SKIN DISEASE that is stage 2B to stage 4.  Follow up magnetic resonance imaging, detailed picture study, of your brain is supported for this problem once per year for the first 5 years after your skin disease was found.  Your records do not show that this applies to you. This decision just means your health plan won't pay for the service.  You can still receive the service, but you will need to pay for it yourself.  {signed} Michele Awobuluyi, MD"   (This was the Blue Cross response to my onc's request for my now annual can check out the entire outrageous story here:  August 2016: And then there's me...)
Researchers, you have the data, the reputation, the expertise, and the clout to put the pressure on insurance companies to provide the care that your patients need.  Do it!!!!
#4.  And since this is one more perfect opportunity to say it, "Michele Awobuluyi, MD, NYU alum - you are an ass and an idiot, a disgrace to your profession and a danger to society."  I hope you google your own name!!!
Being a rattie is tiring!  Hang tough, ratties.  Hang tough. - c


  1. I had 98 brain mets and treated with SRS + ippi. 97 responded, 1 required surgery. All were relatively small. Coming up on 5 years. There is hope, one day at a time.

  2. Amen!!! Glad you continue to do well!