The latest in treatment for advanced brain cancer

Dr Neda Haghighi / 19 Apr, 2022

Radiation Oncologist Dr Neda Haghighi discusses recent advances in treatment for metastatic brain cancer

Metastatic brain cancer (also called advanced or secondary brain cancer) occurs when cancer cells spread to the brain from other parts of the body. This is different from primary brain cancer, which is a cancer that starts in the brain.

Brain metastases occur in approximately 20-40% of people with cancer, with over half of those people developing more than one metastasis (or tumour).

Any cancer can spread to the brain. However, the most common cancers that spread to the brain are lung, melanoma, breast, kidney and bowel cancers.

In recent times, more people are being diagnosed with metastatic brain cancer than ever before. This is primarily because so many people are living longer lives following an initial cancer diagnosis, and the risk of developing brain metastases increases over time. We also now have access to more advanced diagnostic imaging technology, so we are able to detect brain metastases with far greater efficacy and accuracy.

With the development of increasingly advanced treatments in recent years, metastatic brain cancer is now more manageable than ever before. Compared to past decades, when advanced brain cancer was considered one of the final stages of cancer, outcomes have significantly approved.

What are the treatment options for brain metastases?

Treatment options for metastatic brain cancer are determined by how many brain metastases you have, their size and location, as well how the cancer is behaving outside the brain and your own personal health.

Most focal treatments for metastatic brain cancer involve a combination of surgery and radiation therapy. Treatment can also include drug therapies, such as corticosteroid therapy, chemotherapy, targeted therapies and immunotherapy.

How is radiation therapy currently used to treat brain metastases?

The two main types of radiation therapy techniques used to treat metastatic brain cancer are:

Whole brain radiation therapy (WBRT)

WBRT involves radiation therapy to the entire brain, with the aim of destroying even the smallest of cancer cells that may otherwise go undetected.

Unfortunately, this treatment can be associated with significant quality of life effects and is usually only recommended for certain conditions that cannot be treated with targeted approaches.

Stereotactic radiosurgery (SRS)

SRS is not a type of surgery, but a radiation therapy technique that directs highly precise radiation beams with millimetre accuracy to each individual tumour, rather than to the whole brain. It can also be called stereotactic radiation therapy (SRT). For some years now, stereotactic radiosurgery following surgery has been considered the gold standard of care for patients with metastatic brain cancer.

While many brain metastases are controlled using this treatment method, one of the challenges that remains is that up to 30% of patients experience recurrence in the thin layers of tissue covering the brain (known as leptomeninges). This is called leptomeningeal disease (LMD) which typically is very difficult to manage and has a very poor prognosis.

What advances have there been for the treatment of metastatic brain cancer in the last 10 years?

Advances in radiation therapy treatment technology and techniques over the past ten years have significantly improved the treatment outcomes for people with advanced brain cancer, especially in people with multiple metastases which are unable to be removed by surgery alone.

Targeted therapy and immunotherapy treatments are also increasingly being used and are a focus area of many clinical trials.

What is the latest research for advanced brain cancer?

I was proud to initiate a new and first in Australia study which suggests that patients who receive stereotactic radiosurgery before brain surgery (neoadjuvant therapy) instead of afterwards, achieve equal control of brain metastases with a decreased risk of complications including LMD. The aim of the study, which was conducted across two Victorian cancer centres, was to investigate whether treatment with neoadjuvant stereotactic radiation therapy would provide better treatment outcomes for patients with fewer complications.

In a first of its kind, the study compared the outcomes of patients treated with hypofractionated stereotactic radiation therapy, a specialised stereotactic technique that delivers the doses of radiation therapy over three to five days, with a high single dose of stereotactic radiosurgery to the brain.

Hypofractionated stereotactic radiation therapy is used when the tumour volume is large (>2-3cm) and takes advantage of radiobiological principals to minimise the risk of late radiation toxicity on the brain.

For patients with advanced brain cancer, this also means that radiation therapy treatment can be completed in a few days rather than weeks, reducing the time between radiation therapy and surgery which can be an especially stressful time for patients and families.

View the journal article

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