Brain metastases is a diagnosis that is becoming more and more common, particularly because patients are living longer and longer with cancer diagnoses. In the United States, approximately 200 thousand patients are diagnosed with brain metastasis. These are cancers that originate from a different part of the body. For example, lung cancer is the most common, and it ends up depositing the small focus and disease within the brain itself. Now these can lead to very concerning clinical consequences depending on the location of where the brain tumor shows up. For example, some parts of the brain will represent areas where seizures could form. Other parts can cause weakness.

For patients diagnosed with brain metastasis, it is important to seek care at a center like Mayo Clinic, particularly because we are able to offer the entire catalog of different treatment options for that patient. Everything has to be taken into consideration so that when we looked at a patient, it isn't looking specifically at how many brain metastases do they have, or where those brain metastases located, or how many treatments have they had? It has to do with the whole picture of that individual patient, what options they have for future treatment for their systemic disease should also factor into the decisions for how we manage their brain metastases.

In case of brain metastases, the sooner the patient sees the specialist, the better. The treatment options vary again, depending on the number of the lesions, number of metastasis, the size of the metastasis, where they are in the brain. So it all depends on when in the course we catch them. But the general rule is the sooner you can see a physician, the better. And again, at a place where multi-specialty approaches are available.

Diagnostic options for patients with brain metastasis: there's so many. Imaging is very, very important. How can we get a diagnosis without having to expose the patient to a scalpel or a needle. So I think that we are cutting edge imaging tools, your MRI, PET scan spectroscopy, and other technologies as well. But also it's important to have technology, but you need the people who know how to interpret that technology. Nowadays, even the development of technology, we are able to treat smaller lesions in a very localized, sort of a pinpoint fashion so that spares the rest of the brain. So we are striving to do that.

Mayo Clinic has tremendous expertise in treating patients with metastatic brain tumors. The treatments available for metastatic brain tumor vary from surgery to radiation, to newer drugs that penetrate the blood-brain barrier in order to get to the brain. It's really a combination of treatments that is important for the patients to be able to receive effectively. For patients with metastatic disease, there's no one right answer. It really requires a collaborative team effort in seeing the patient with metastatic disease, For example, in the surgical realm there’re advances in surgical techniques enabled to taking out metastatic disease safely. For medical therapy, there are a number of newer agents such as immunotherapies that allows treatment of metastatic disease to the brain. Within radiation oncology, we've advanced the technology where we can offer patients state-of-the-art radio surgical techniques, proton beam therapy techniques, and more conventionally fractionated stereotactic techniques. 

For metastatic tumors, we typically would use an MRI. MRI with contrast is gold standard for diagnosing and monitoring brain metastases. But there are also some additional techniques that we sometimes use to interrogate the brain lesions. And one such technique is PET scan. PET scans can be done in combination with a computer tomography or CT, but it can also be done with an MRI. And here at Mayo, we do have a PET MRI, which is a unique technology that allows us to obtain images of the tumor itself, but also kind of look at the metabolic activity of the area and can allow us to kind of assess if the lesion is active or not. What's changing in oncology is that there's more and more medications now available that are able to bypass the blood-brain barrier that it was previously considered to be kind of an obstacle for most of the chemotherapies that work in the system but don't work in the brain. So we now have those drugs that, that cross the blood-brain barrier. And many patients with brain metastasis can actually be treated with medications before the surgeon or radiation oncologists even touches them. So that's sort of the changing field and I think we're going to see more and more patients benefiting from medical treatment before surgery and radiation is necessary. 

We do have some immunotherapy options as it pertains to patients with brain metastasis. For patients who have melanoma or have lung cancer that has spread to the brain, there are some immunotherapies which had been proven to be extremely effective in those instances. Same is true with targeted drug therapy in terms of what options are available for patients with brain metastasis. One of the things that we're doing and that's on the forefront in terms of treatment of patients with brain metastasis is an early phase trial where we're using vaccine therapy to treat brain metastasis. This is a novel treatment for brain metastases that has been utilized and still is in trial with glioblastoma. We hope that we'll see another angle that we're able to treat some patients to have an enduring effect. Within the majority of clinical trials that are happening here at this campus at Mayo Clinic in Arizona as well in Rochester and Florida, looking at glioblastoma or brain metastasis, we are including a quality of life component for each of those trials. And so we never want to lose sight that although some of the treatment options are novel and exciting, if it limits the patient's quality of life, we need to start thinking about things in a different way. 

For many patients, the diagnosis with a stage four cancer is seen as a life sentence that is measured in a very finite number of weeks or months. And to not have the opportunity to know that there may be other systemic treatments available to them or that they may benefit from very specific, almost aggressive care. Even in the setting of brain metastases is one of the things that I think we at Mayo Clinic do particularly well. Again, drawing from the expertise that we have, from all of the sub-specialists in all of the various areas of oncology. We can take an individual patient referred to us with a specific problem, i.e. brain metastases. And then take a step back to sort of look at their overall clinical picture, to then better determine what is the most appropriate option for them in terms of managing their brain metastases. The expertise for metastatic brain tumors is so widespread and it's a wide spectrum. First, you need representation of expertise in every possible tumor type. Our oncology practice is very diverse and has so many experts in there. The other thing is also the ability to work together, because what if the person has a brain metastasis? But the problem centrally is the main problem with seizures. Can we get the best seizure doctor to help out with that? Or what if it's pain, we get a pain doctor. Or what if we need to take out that tumor? We need a neurosurgeon who's expert at something like that. But after the surgery, chemo and radiation, we always have to make sure that the right doctor or the right doctors are chosen for that patient.