Brain Mets from Ovarian Cancer

Hi,

My mom was diagnosed with OVCA stage IV last year and received 6 x chemo taxol/carboplatin.  6 months after completing the chemo, she was experiencing stroke symptoms (July 09).  MRI showed that there are 4 tumors on the brain.  Per neurosurgeon, the tumors can't be operated because of the position.  She received Novalis (radiosurgery). A month later she was in coma, because of increasing in brain pressure.  After high dosage of steroid, she was ok.  MRI result showed that there was no changes in tumor sizes.  2 weeks ago she was experiencing the same symptoms as before (stroke symptoms).  MRI result showed that there are 2 other lesions less that 1 cm and the increasing mass of the tumors.  The oncologist and the neurosurgeon said that there is no more that they can do, they can't do another radiation.  We've seen another oncologist and she suggested to have another round of chemo with CPT11, Avastin and Cisplatine for 6 weeks.  My question is whether chemo treat the brain tumors metastasis from OVCA.  Is there any other way to treat the tumors beside chemo?  My mom is very weak right now because of the swelling in the brain.  Thanks.

[Annekathryn Goodman, M.D.]

HI There
I am so sorry to hear about your mother. What a nightmare. This is a devastating problem.   Brain mets are very rare. It sounds like she has had appropriate treatment. The fact that there are multiple tumors  and new ones keep developing means that there is a significant break in the blood brain barrier and cancer cells are coming across.

I agree with the doctor's recommendation for chemotherapy that can across the blood brain barrier such as CPT 11.
You should ask her doctor about the role for intrathecal  chemo  which means putting chemo directly into the spinal fluid. I suspect that she has too much cancer in her brain for that to be effective or safe.

I have pasted a link for an excellent review article on this topic.

http://theoncologist.alphamedpress.org/cgi/content/full/11/3/252

best wishes

[bamboo123456]

I'm sorry to hear about your Mom, and I know it's not easy and pray that your Mom gains strength and her condition improves.

My Mom also went through similar experience.  She was dx 3c last year, had surgery + 6 rounds of chemo + radiation and had achieved remission for about 5 months.  Then she started having severe headaches, they found large lesion about 3.5cm.  She was treated with gamma knife radiosurgery, which requires another MRI scan on treatment day.  In total they found 8 lesions, all of which were treated.  Initially she was also very weak and in pain due to swelling and was hospitalized for 8 days on steriod. But after 2 month follow up scan, all previous smaller tumors were gone and the larger tumor was significantly reduced.  About 3 weeks ago, she had another gamma knife session for second treatment of the larger tumor, and plus 3 new tumors which were detected.  Her condition is so much more improved than 2-3 months ago.  She is now on 3rd cycle of Topotecan, I've read that it can pass BBB but I understand chemo in general is not very effective for treating brain tumors.

Based on the information I can find on the internet, it seems that gamma knife is highly effective and can be used as a maintenance treatment for new tumors as long as they are detected early.  My Mom is recommended to have a scan (CT or MRI) every 2 months.  I'm not sure Novalis is very similar to gamma knife, but not sure why the Dr says she can not receive any more treatments?

I hope this helps, and all the best to you and your Mom.