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Dr. David
Dr. David, Board Certified MD
Category: Neurology
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Experience:  Board Certified Physician
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My sister in law has been diagnosed with 3 secondary lesions

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My sister in law has been diagnosed with 3 secondary lesions on the surface of her brain having had a double mastectomy last year. She has been scanned and there is no further cancer at the moment in her body. She lives in Penang and we have just returned from there where we set up her care. She is now heavily sedated and has just started whole brain radio therapy. She started to experience severe pain and fitting quite quickly after diagnosis which was probably late in coming - she had been told that she had flu symptoms upon her first enquiry at her GP. We left her heavily sedated but out of pain.Should we accept the common view that seems to be that she is now expected to live for a short time, heavily sedated and that we should look for a hospice. Or, should we ask for and sek out one of the more radical new treatments in Malaysia such as "cyber technology" which is about more precise treatment of the brain with radiotherapy. Or indeed the immunotherapeutic trials in the UK that have recently been reported upon - can she access these still on trial drugs in Malaysia?
Submitted: 1 month ago.
Category: Neurology
Expert:  Shantal-Mod replied 1 month ago.
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Expert:  Dr. David replied 1 month ago.

This is Dr. David

I am a radiation oncology cancer doctor.

I am sorry about your sister.

cancer on the surface of the brain is called leptomeningeal spread

this is a difficult situation and would not benefit from focused stereotactic radiosurgery or cyberknife radiation therapy

she needs whole brain radiation therapy down to the C2 cervical spine level along with high doses of dexamethasone steroid therapy

the whole brain radiation can help kill the cancer cells.

the radiation should be daily over 25 days to a total dose of 45Gy and areas of gross disease which can be seen on the MRI scan can be pushed to 50.4Gy.

she also needs a total spine MRI scan to check for drop metastasis to the dura down in her spine.

in some cases, some patients can get intrathecal chemotherapy into the CSF fluid around the brain through an omaya catheter right into the brain.

chemotherapy agents like methotrexate could help fight her brain cancer

let me know if you have questions.

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