? Lao Liu, a 70-year-old lung cancer patient, is currently taking targeted drugs. Lao Liu has had intermittent headaches and dizziness since last month, especially when he got up in the morning. In the last week or two, he began to have symptoms of weakness in his left hand and left foot, and was sent to the emergency room by his family.
The examination results show that there are abnormal masses on both sides of the brain and cerebellum, and they are currently undergoing a series of further examinations in the hospital. The attending physician assessed the necessity of follow-up brain radiotherapy, so he referred him to the Department of Radiation Oncology. As soon as Liu entered the clinic, he could not wait to ask.
This is a very common scene in the consulting room of radiation oncologists. Usually in this case, the doctor will advise the patient to receive "whole brain radiotherapy". ?
The biggest worry of patients is that their brains will become dull after treatment, which may increase the trouble of family care, and the care of relatives and friends will also cause invisible pressure on them. If the symptoms of the "wife in the next bed" are very serious, this feeling of tension and anxiety will be felt when you walk up a flight of stairs again. ?
What I want to tell you is that other people's symptoms usually "may not" happen to you. For patients with the same condition, doctors generally follow the so-called "treatment guidelines" in prescription or treatment. Therefore, if they are all patients with brain metastases, the therapeutic dose of radiation is similar. ?
But this is the same concept as when pregnant, some mothers throw up, and some mothers run around without feeling. Receiving the same dose, different patients have different reactions. Therefore, patients really don't have to worry about being like him because of the reactions of other patients. ?
There is no denying that whole brain radiotherapy does interfere with and affect nerve conduction in the brain. According to the current medical research, it is known that in the first three months after treatment, patients' short-term memory and fluency in speech will have obvious effects.
But all medical care adheres to the spirit of "the advantages outweigh the disadvantages". When the tumor grows enough to cause headache, dizziness or weakness of hands and feet, the improvement of symptoms and quality of life of patients after treatment is definitely higher than that of becoming dull or tired after treatment. ?
Will it get worse after taking pictures? ?
Usually, the most difficult choice for patients' families is to worry that their decisions will make their loved ones more uncomfortable. It is really not easy to make this decision. Doctors can't correctly predict whether the symptoms will "definitely" improve later. ?
What patients and their families can do is to make the most suitable choice according to the current situation and the information provided by doctors. But family members should remember one thing: no matter which way they choose in the end, the original intention of this choice is "I hope patients can be more comfortable." ?
Sometimes the changes of patients are not directly related to the decisions you make. When some patients came for treatment, their physical strength was weak and the expected effect was not good, but after a course of treatment, the tumor responded well and their physical strength improved rapidly. Some patients came for treatment with a small tumor, but it didn't take long for the tumor to bleed after treatment, which brought inconvenience to hands and feet. ?
Many things, how the condition will change, are actually not decided by doctors or patients; As for the family, there is no need to take all the responsibility on yourself, because it is too heavy and too hard. ?
So, what is brain metastasis? ?
Cancer cells mutate into human blood, move to the brain with blood flow, and then develop into another new tumor. About 9-20% of cancer patients will eventually have brain metastasis. The incidence of some cancers such as non-small cell lung cancer, small cell lung cancer, breast cancer and melanoma will be higher.
What are the symptoms of brain metastasis?
Symptoms related to elevated brain pressure (because tumors grow in the brain and occupy the original space of the normal brain): head swelling, headache, nausea, vomiting, etc. The symptoms of headache are often the most serious in the morning.
Nervous system symptoms: It is related to the location of brain metastases and has different manifestations according to the location of the tumor; For example: limb weakness, walking instability, blurred vision, limb spasm, consciousness change, personality change (sudden irritability or abnormal silence), memory defect, irrelevant answer, unable to express self-will, etc.
Tumor bleeding: There are many abnormally proliferating blood vessels in the tumor. If there is bleeding, there may be symptoms similar to a stroke.
Seizure: The brain discharge (nerve conduction potential of brain cells) is abnormal due to the tumor in the brain, which can lead to loss of consciousness, involuntary convulsions of hands and feet, upturned eyes, foaming at the mouth and so on.
Therefore, if brain metastases are not actively treated or poorly controlled, tumors will affect the function of daily life and quality of life.
Why do you need whole brain radiotherapy?
Treating tumors and relieving symptoms: Is brain radiotherapy palliative? . The main purpose is to relieve symptoms, maintain a better quality of life and slow down the growth of cancer cells, but it cannot completely eliminate cancer cells. In addition, if the tumor can shrink, the use of steroids can also be reduced.
Prevention of other brain metastases and regrowth: The number of tumors actually metastasized to the brain is usually more than that shown on the magnetic resonance imaging (MRI) image; Whole brain radiotherapy can reduce the probability of brain metastasis in other parts of the brain in the future.
The effect of intensive follow-up chemotherapy: the brain has a special "blood-brain barrier (BBB)", which will prevent chemotherapy drugs or targeted drugs from entering the brain, thus reducing the therapeutic effect; Animal experiments and human studies have found that whole brain radiotherapy can reduce the blocking function of blood-brain barrier for about three to four months. After receiving treatment, it can increase the concentration of chemotherapy drugs or targeted drugs in the brain and strengthen the follow-up curative effect.
About 70-80% patients can successfully complete the whole course of treatment, and about 20-30% patients will have obvious side effects after receiving whole brain radiotherapy.
How long does a course of treatment take?
The most common irradiation method is once a day (Monday to Friday), * * * is 10- 14 times, and the total dose is 25-35 Gy. Please consult your attending physician for details. ?
How would I feel?
● Feeling of fatigue and lethargy: About 50% patients will have obvious fatigue, which is most obvious in the second to fourth weeks after treatment, and it takes about 1-2 months to recover slowly. During the treatment, there are many other factors that can also make patients feel tired: commuting, lack of sleep, insufficient food intake, pain or other discomfort, nervousness or depression due to treatment and drug use, etc.
●? Poor appetite: about 50% patients will also have it. Patients will feel that they don't want to eat, but their digestion and absorption are generally normal.
●? The original neurological symptoms are temporarily aggravated: this is because the tumor may have slight local edema at first after irradiation, and steroids and antiemetics are usually used to relieve your symptoms.
●? Headache, dizziness, nausea and vomiting: treatment? During this process, patients may have temporary slight headache, dizziness, nausea and vomiting due to the temporary slight increase of brain pressure. Propranolol can usually relieve symptoms, and sometimes patients may need to use drugs to reduce brain pressure and antiemetic drugs. Most patients show poor appetite and relatively little nausea and vomiting.
●? Hair loss: 2-3 weeks after starting treatment. When you wake up in the morning, you will find too much hair on the pillow, or you will lose too much hair when you take a shower. It is suggested that long-term patients cut their hair short before hair loss, and use a soft hair comb to avoid scalp, avoid nail scratching and reduce hair loss. Excited? Suitable. Because the total dose of treatment is moderate, the hair of patients usually grows back to its original length after 3-6 months of treatment. Wear wigs, hats or headscarves as needed. Patients who receive local brain irradiation will only lose their hair where X-rays pass.
●? Skin inflammation: There may be skin inflammation on scalp, ear, external auditory canal and back neck. At first, the skin may be slightly red or light brown, and then it may become redder or darker. Avoid scratching your scalp when you feel itchy. Usually these symptoms will gradually disappear after 3-4 weeks. In addition, if you take targeted drugs (such as Aretha, dextran or Teflon) or bask in the sun at the same time, there may be obvious rashes on the skin surface.
Older patients (over 60 years old), patients with large tumors or severe edema may have more obvious symptoms. ?
What are the side effects in the later period?
? Chronic otitis media: About 65,438+0/3-65,438+0/4 patients will suffer from chronic otitis media, because radiation passes through both inner and middle ears, which will cause temporary hearing deterioration. Some patients will be complicated with hydrocephalus in the middle ear. If it is serious, please consult an otolaryngologist for local treatment and symptom treatment.
? Memory decline, speech fluency and cognitive function are affected: the first three months after treatment are the most obvious. According to foreign large-scale research, most patients will gradually recover their memory and cognitive effects after three months of treatment, but a few patients have a memory loss of more than 12 months, and the recovery degree is relatively poor. If the patient is older (> 70 years old) or has other chronic diseases such as stroke and diabetes before, the recovery speed will be slower.
? Brain tissue necrosis: the current treatment technology is extremely rare, and if combined with high-dose treatment such as gamma knife, the risk will increase slightly.
? White matter lesions: there are very few patients, but once they occur, there is no effective treatment. Symptoms are similar to severe Alzheimer's disease.
Do I have any other choice?
◆ Gamma Knife: When the number of tumor metastases is small (
Its characteristics are: good fixation, high accuracy (due to the use of nail-attached metal headgear), short course of treatment (only once), high single dose (about 15-24 Gy), and small irradiation range (so few side effects). But it needs to be evaluated by neurosurgeon before it can be carried out; It is not suitable for every patient, and it costs about 1.5- 1.8 million to treat a course at one's own expense. The following table is a simple comparison table between knife addition and whole brain radiotherapy:
◆? Surgical resection: when the tumor causes obvious compression symptoms, severe edema and superficial tumor location, and the neurosurgeon considers that the physical condition and physical strength are suitable for surgery, neurosurgery can be selected to remove the tumor to reduce the discomfort caused by the tumor. After operation, most patients still need to receive whole brain radiotherapy or local intensive radiotherapy at the surgical site to obtain better disease control. ?
Note: the general direction of treatment of brain metastases
A only 1-4 metastatic tumor: there are many treatment schemes, and the appropriate methods can be discussed with the attending physician.
? □ Operation+postoperative whole brain radiotherapy
□ ? Whole brain radiotherapy+local intensive radiotherapy
□ ? Local radiotherapy (including sabre or other stereotactic radiotherapy)
□ ? Targeted drug therapy (mainly suitable for patients with small and asymptomatic tumors)
Conclusion: Combined with whole brain therapy, there is a good brain control rate, and local radiotherapy or targeted drug therapy alone has a high risk of brain recurrence. ?
B. More than 4 metastatic tumors: Whole brain radiotherapy is the main method, and local intensive therapy can be supplemented if there are larger tumors.
C. Older patients or patients with poor physical strength: Whole brain radiotherapy is the main method.