Future Treatment and prognosis of Brain Cancer(metastatic breast cancer)

[Bob__0__0]

Posted by Bob on May 07, 1999 at 11:31:41
Approximately 8 years ago my wife was diagnosed with metastatic breast cancer at the age of 36 soon after the birth of our first child. She chose to have a lumpectomy and undergo radiation and chemotherapy. Her breast cancer was severe in that 12-13 of her 20 lymph nodes were involved and the tumor biopsy showed that it was an estrogen receptor. At one point we were considering a bone marrow transplant to increase her odds of survival but sampling of her bone marrow indicated that it contained cancer cells. After the radiation and chemotherapy was completed her bone marrow was tested again and it did not show any signs of cancer cells and for 6 years she remained cancer free. Approximately 1.5 years ago she had a seizure and was rushed to the hospital. An MRI was performed which showed a mass (brain tumor). The tumor was removed and proved to be cancerous. My wife underwent radiation and chemotherapy for several months and seemed to be doing fine. The Doctor put her on anti-seizure medicine and steroids which have had numerous side effects. Approximately 5 months ago she went in for another MRI which was unable to define the area where the mass was removed, so the Doctor performed a needle biopsy which showed that the tumor/cancerous cells were still present. She recently concluded a second series of radiation and chemontherapy. My questions are as follow:
1)What other types of treatments are available that might be considered experimental?
2)Should she continue with the treatment she is currently receiving which does not seem to abate the growth of the brain tumors (metastatic breast cancer)and has numerous side effects?
3)Considering the information that I have supplied, what type of prognosis do you think that my wife has? None of the Doctors want to commit to any timeframe or statistic and in most cases seem to be very optimistic.  

Posted by CCF Neuro[P] MD, RPS on May 08, 1999 at 15:18:30
Dear Bob:
I am really sorry to hear about your wife.  Not knowing what chemotherapeutic agents that your wife has been on, I will just make a guess that she has likely been on the most current multi-**************.  Most major centers follow study protocols that are really kept current.  I would imagine that you wife is on the most current and cutting edge of chemotherapy.  We at the Cleveland Clinic have just submitted the results of a stage II trial of recurrent brain cancers/metastases which suggests that thiotepa may be a help in the short term.  However, the data is only indicative of therapeutic help.  I would get on the National Cancer Institutes website and hunt for other trials.
It is really hard for me to answer whether your wife should continue her current therapeutic agents.  You need to sit down with all parties concerned and discuss the pros and cons, along with the options.  These answers are never easy and for me to believe that without knowing the complete situation, not appropriate to answer.  (I'm just trying to be honest).
Prognoses is not an exact science nor do any of us have the ability to predict the future (I am not trying to be smart or sarcastic).  Not being able to see the MRIs, tumor histology, etc. I really don't think I can comment.  Brain metastases are really difficult to control, but we have seen some real great outcomes.  I wish I could tell your something, but I don't know what to say.
Sometimes when doubts and concerns creep up, one of the best things a patient can do is seek a second opinion.  Maybe that option might help you and your wife settle in your minds that things are being handled properly and for your wife's best interest.  No good physician would want anything less.
Sincerely,
CCF Neuro[P] MD