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After effects of full brain Radiation

rosie43539's picture
rosie43539
Posts: 56
Joined: Mar 2003

My husband has Stage 4 renal cell cancer with lesions on his lung, liver and brain. He underwent full brain radiation but had no luck with it. From what I have read, the effects can last for a long time and new ones develop for years afterward. I would like to hear from anyone who has had full brain radiation so maybe I can be prepared for what might happen next.
Rosie

gdpawel's picture
gdpawel
Posts: 548
Joined: May 2001

The initial approach to using radiation postoperatively to treat brain metastases, used to be whole brain radiation, but this was abandoned because of the substantial neurological deficits that resulted, sometimes appearing a considerable time after treatment. Whole brain radiation was routinely administered to patients after craniotomy for excision of a cerebral metastasis in an attempt to destroy any residual cancer cells at the surgical site. However, the deleterious effects of whole brain radiation, such as dementia and other irreversible neurotoxicities, became evident.

This raised the question as to whether elective postoperative whole brain radiation should be administered to patients after excision of a solitary brain metastasis. Current clinical practice, at most leading cancer centers, use a more focused radiation field that includes only 2-3cm beyond the periphery of the tumor site. This may involve therapy once a day for about six weeks and allows radiation up to 60gy. This begins as soon as the surgical incision has healed.

Many metastatic brain lesions are now being treated with stereotactic radiosurgery. In fact, some feel radiosurgery is the treatment of choice for most brain metastases. There are a number of radiation treatments for therapy (Stereotatic, Gamma-Knife, Brachyradiation and IMRT to name a few). These treatments are focal and not diffuse. Unlike surgery, few lesions are inaccessible to radiosurgical treatment because of their location in the brain. Also, their generally small size and relative lack of invasion into adjacent brain tissue make brain metastases ideal candidates for radiosurgery. Multiple lesions may be treated as long as they are small.

The risk of neurotoxicity from whole brain radiation is not insignificant and this approach is not indicated in patients with a solitary brain metastasis. Observation or focal radiation is a better choice in solitary metastasis patients. Whole brain radiation can induce neurological deterioration, dementia or both. Those at increased risk for long-term radiation effects are adults over 50 years of age. However, whole brain radiation therapy has been recognized to cause considerable permanent side effects mainly in patients over 60 years of age. The side effects from whole brain radiation therapy affect up to 90% of patients in this age group. Focal radiation to the local tumor bed has been applied to patients to avoid these complications.

Radiation necrosis may result from the death of tumor cells and associated reaction in surrounding normal brain or may result from the necrosis of normal brain tissue surrounding the previously treated metastatic brain tumor. Such reactions tend to occur more frequently in larger lesions (either primary brain tumors or metastatic tumors). Radiation necrosis has been estimated to occur in 20% to 25% of patients treated for these tumors. Some studies say it can develop in at least 40% of patients irradiated for neoplasms following large volume or whole brain radiation and possibly 3% to 9% of patients irradiated focally for brain tumors that developed clinically detectable focal radiation necrosis. In the production of radiation necrosis, the dose and time over which it is given is important, however, the exact amounts that produce such damage cannot be stated.

Late effects of whole brain radiation can include abnormalities of cognition (thinking ability) as well as abnormalities of hormone production. The hypothalamus is the part of the brain that controls pituitary function. The pituitary makes hormones that control production os sex hormones, thyroid hormone, cortisol. Both the pituitary and the hypothalamus will be irradiated if whole brain radiation occurs. Damage to these structures can cause disturbances of personality, libido, thirst, appetite, sleep and other symptoms as well. Psychiatric symptoms can be a prominent part of the clinical picture presented when radiation necrosis occurs.

Aggressive treatment like surgical resection and focal radiation to the local tumor bed in patients with limited or no systemic disease can yield long-term survival. In such patients, delayed deleterious side effects of whole brain radiation therapy are particularly tragic. Within 6 months to 2 years patients can develop progressive dementia, ataxia and urinary incontinence, causing severe disability and in some, death. Delayed radiation injuries result in increased tissue pressure from edema, vascular injury leading to infarction, damage to endothelial cells and fibrinoid necrosis of small arteries and arterioles.

Again, whole brain radiation is the most damaging of all types of radiation treatments and causes the most severe side effects in the long run to patients. In the past, patients who were candidates for whole brain radiation were selected because they were thought to have limited survival times of less than 1-2 years and other technology did not exist. Today, many physicians question the use of whole brain radiation in most cases as one-session radiosurgery treatment can be repeated for original tumors or used for additional tumors with little or no side effects from radiation to healthy tissues. Increasingly, major studies and research have shown that the benefits of radiosurgery can be as effective as whole brain radiation without the side effects.

Sometimes, symptoms of brain damage appear many months or years after radiation therapy, a condition called late-delayed radiation damage (radiation necrosis or radiation encephalopathy). Cerebral radiation necrosis is a debilitating, potentially life-threatening and increasingly frequent problem in patients with brain tumors. These symtoms can be from progression of cancer or it can be caused by the side effects of whole brain radiation. However, the FDG-Pet Scan can provide a reliable technique for diagnosing tumor recurrence from necrosis. Hyperbaric Oxygen Therapy (HBO) is now a useful terapeutic option for patients with confirmed symptomatic radiation necrosis.

The most common condition treated at some Hyperbaric Oxygen Therapy Centers is tissue injury caused by brain radiation therapy for cancer. Wound healing requires oxygen delivery to the injured tissues. Radiation damaged tissue has lost blood supply and is oxygen deprived. Chronic radiation complications result from scarring and narrowing of the blood vessels within the area which has received the treatment. Hyperbaric Oxygen Therapy provides a better healing environment and leads to the growth of new blood vessels in a process called re-vascularization. It also fights infection by direct bacteriocidal effects. Using hyperbaric treatment protocols, "most" patients with chronic radiation injuries can be cured.

sleepless in jersey
Posts: 185
Joined: Feb 2011

I know this is a 7yrs ago post don't know if you still come on? Have some questions for you as to Mom having effects we think from WBR will get a better idea on Monday or Tuesday hopefully. Mom's getting scans today.
Hope to hear from you!

dkparm
Posts: 1
Joined: Jan 2012

Hello gdpawel,
I would like to know how you know so much about the whole brain radiation. Are you a doctor? Also, I am researching hyperbaric chamber treatment for this. My husband had it a few months ago and after having read what can go on in the future, I am getting a little scared. Right now he is doing ok, and is actually improved from the lymphoma that was in his spinal fluid and CNS. Do you know anything about the hyperbaric oxygen therapy? I see pros and cons. I just need some qualified information at this point and don't plan to jump into ANYTHING ever again without doing massive research. Thanks very much.
DPW

wj01
Posts: 1
Joined: Jun 2013

Dear All,

My dad had wholebrain radiation prophylactically 25Gy and now has very severe loss of appetite, somnolence and fatigue and weakness.

Anyone has experienced this? Does it subside spontaneously? How long does it last?

He started these symptoms 2 weeks after radiotherapy completion and it has been now 10 weeks after completion of radiotherapy and he still has the symptoms

 

thx

wj01

 

njecab
Posts: 6
Joined: May 2013

hi wjo1,

Even my grandpa had same problm with severe loss of appetite ,fatigue, weakness. We didn go for anymre radiation, instead we went for a new treatment SPMF therapy. which is a non invasive and without any side effects.. Now we are happy to see him as he s doing well and more energetic. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919998/

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