Home Forums Melanoma Diagnosis: Stage IV Decisions with treatment to brain mets

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    I have posted before as a new member with my husbands brain mets, well we have had the meeting with the Dr about radiotherapy and he has suggested my husband has whole brain therapy over cyber knife ? He has 2 lesions messuring 3m, the Dr is worried with his previous brain met that was the size of a small manderin that was removed and the fact that the rest of his body is stil reacting to zelboraf his melanoma prefers to settle in the brain and he fears that there could be more micro lessions undetected by scans lerking? Now this is where some opinions would really help??? He has sugested either we start WBR straight away or we wait for the next scan (6weeks) and see if the two lessions have stayed only two in which case use cyber knife or if more have cropped up then use WBR ??? We have no idea which way to go or what’s best!! If there’s anyone who could help with what’s the best way to go it would be sooooo much appreciated…. Thank you



    Hi Kay,

    I’m sorry your husband and you are going through this. Are you saying that his two lesions 3mm each?

    I can share with you my own history, so you can compare it at least.

  • Brain met #1 2.7 x 2.4 cm resected via craniotomy 10/2010

  • Brain met #2 1.8 x 1.2 cm cyberknifed 11/2010 (plus #1’s tumor bed)
  • Brain met #2 (recurred) 3.3 x 3.4 cm resected via craniotomy 6/2011
  • Brain met #3 (new) 2.4 x 2.2 cm also resected via craniotomy 6/2011
  • Brain met #4 (new) 1.4 x 0.9cm gamma knifed 6/2011 (17 days after craniotomy)
  • Brain met #5 (new) .3mm also gamma knifed 6/2011 (plus tumor beds for #2/#3)
  • No WBR has taken place to date. So far everything they see on MRI in my brain has been stable or shrinking since fall 2011. I’m BRAF negative. My oncologist (and me) were also worried about micrometastases, Yervoy was the auxiliary game plan for that. My facility is considered by some to be in the top 5 in the U.S. for neurosurgery, for what that’s worth.

    My impression from the webinar on radiation to the brain on this site with Veronica Chang (head of Gamma Knife at Yale) is that she would want to zap those two small (3mm?) mets immediately — I believe she says that explicitly on the webinar. Webinar (highly recommended) here, http://www.melanomainternational.org/news/brain_metastases1.html” class=”bbcode_url”>http://www.melanomainternational.org/news/brain_metastases1.html. My impression from my own radiation oncologist is that she prefers Gamma Knife to WBR when there’s a choice, she is also a fan of the Gamma Knife system. I guess I am too.

    Knocking on wood for both of us.

    – Kyle

Catherine Poole

Wonderful answer Kyle to this post and yes the doc from Yale definitely preferred Gamma Knife. Kay, I wonder if you should seek a second opinion? I don’t think waiting is a good idea either but whole brain can be very tough to go through. Keep in touch with us and let us know how things are going.


One more personal experience story for what it’s worth. Two small brain mets were found in early October last year. This prompted the decision for Yervoy and targeted radiation of the tumors. No surgery was suggested because of there being two rather than one. The team at the University of Michigan staged it so that the Yervoy was started at the very end of October and the SRS procedure (similar to Gamma Knife) was done in early December, two months after the brain tumors were found. The purpose of delay was to increase the synergistic effect of the ipi and the radiation. I consulted with Sloan Kettering about the delay in the radiation because I had concerns about the delay in its applications. Dr. Chapman at least felt that it was a reasonable approach and no rush was needed. The two mets are now stable or shrinking and no further have appeared as of two weeks ago.


Excellent news there Frank!

You know buddy, you may be an ideal candidate now for a PD1 trial.

I’m just say’n. ;)



Hi all

Thank you all so much for your very helpfull replies, we are now armed with a lot more confidence in which path we want to take. We are going to make a call first thing in the morning to air our preference and get them zapped ASAP! Will keep you all informed how things go, sending love and hope to all


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