Secondary brain and spinal tumors require prompt evaluation and leading-edge treatment. That's why specialists from the Seattle Cancer Care Alliance (SCCA) Brain and Spine Metastases Clinic review cases seven days a week, as needed, so patients receive care as soon as possible.
Neurosurgeon Anubhav Amin, MD, understands the importance of being available on short notice to provide timely recommendations. “Sometimes a patient’s symptoms start off mild, but they can decline rapidly,” says Dr. Amin. “Other times, patients need rapid surgery to stabilize their condition. Our multispecialty team works directly with referring providers to provide efficient, seamless, coordinated care for the patients we serve.”
Having a multidisciplinary team evaluate each patient’s case is also critical, says neuro-oncologist Vyshak Venur, MD. “The management of patients with brain metastases has evolved significantly over the last decade,” he says. “There are many types of novel therapeutic strategies available today. Determining which ones are best for each patient is complex and requires coordination among team members.”
SCCA, Fred Hutch and UW Medicine offer all the latest resources for the care of brain and spine metastases, including leading edge imaging, therapies and clinical trials. Members of the Brain and Spine Metastases Clinic can quickly draw on these resources to develop a comprehensive and coordinated plan.
Advanced imaging protocols
SCCA’s neuroradiology team has created special imaging protocols to overcome the unique challenges of brain and spine metastases, including:
- Tumor growth vs. radiation necrosis: In patients previously treated with radiation, traditional imaging methods do not accurately distinguish tumor growth from radiation necrosis. Using special protocols, SCCA radiologists can better assess whether imaging shows active tumor growth or radiation-related changes.
- Thecal sac imaging: A clear view of the spinal cord is critical when planning treatment for spinal tumors. SCCA radiologists skillfully perform CT myelograms, which provide a better view. This complex procedure involves injecting contrast agent into the thecal sac.
- Metal artifacts: For tumors of the spine, it can be challenging to use MRI to plan radiation therapy in patients who have received screws and rods. SCCA radiologists use advanced MRI techniques that help reduce metal artifacts and allow better visualization of the spine.
Novel therapeutic strategies
Physicians at SCCA, Fred Hutch and UW Medicine lead the field in neuro metastases treatments and provide personalized care for each patient.
“Coordinating treatment of the primary cancer and neuro metastases can be tricky. This is where our timely, multidisciplinary approach helps,” says Dr. Amin. “We’re used to communicating effectively to get everyone on board and coordinating multiple levels of care.”
Some of the novel treatment options offered at SCCA, Fred Hutch and UW Medicine include:
Stereotactic radiosurgery (SRS)
Precision radiation therapy techniques such as stereotactic radiosurgery (SRS) provide targeted treatment for secondary brain and spine tumor treatment. They deliver highly contoured radiation that targets the tumor while reducing toxicity to surrounding healthy tissues.
SCCA, Fred Hutch and UW Medicine offer a full range of SRS platforms, including Gamma Knife® and linear accelerator (LINAC) radiosurgery. Surgeons and radiation oncologists coordinate closely to develop complex SRS treatment plans.
Laser interstitial thermal therapy (LITT)
Laser interstitial therapy (ITT) is a minimally invasive treatment that uses a laser catheter and heat to ablate the tumor. Physicians at SCCA, Fred Hutch and UW Medicine frequently use this targeted technology to treat brain tumors and now offer it for tumors of the spine.
Ommaya reservoir treatment strategies for leptomeningeal metastasis
In general, people with leptomeningeal metastasis (also known as leptomeningeal carcinomatosis or LMC) have limited treatment alternatives and a poor prognosis. Ommaya reservoir treatment delivers chemotherapy or targeted immunotherapy directly to the cerebral spinal fluid via an intraventricular catheter system. This technique helps chemotherapy and targeted therapy agents bypass the blood-brain barrier.
Proton radiation therapy
Proton therapy can help treat patients who received radiation and are at high risk of toxicity from repeat treatment. It can also be life-extending in patients with leptomeningeal metastasis. SCCA’s Proton Therapy Center is the only center within an 800-mile radius of Seattle that offers proton therapy.
Brain mapping
The best treatment option for secondary brain and spinal tumors is often cranial surgery to resect the tumor while the patient is conscious. During brain mapping, the surgical team stimulates brain structures around the tumor while testing neurological functions. This helps the surgeon remove the tumor while avoiding areas that control important functions.
Vertebroplasty
Vertebroplasty is a minimally invasive procedure for patients with fractured vertebrae due to tumors in the spine. In this procedure, the surgeon inserts a needle into the fracture site using image guidance and injects human grade cement. As the cement hardens, it stabilizes the bone and reduces pain. Vertebroplasty can reduce the need for more invasive surgery.
Effective strategies to control symptoms
People with brain and spine metastases experience a range of debilitating symptoms. “One of the goals of our clinic is not just to provide treatment options for our patients, but to take care of their symptoms and improve their quality of life,” says Dr. Amin.
Medications SCCA physicians use to manage symptoms include:
- Anti-epileptics to control seizures
- Steroids such as dexamethasone to relieve neurological symptoms such as loss of balance, headaches and seizures
- Monoclonal antibodies such as bevacizumab to treat radiation necrosis
Multispecialty support services
The core secondary neuro tumor clinic team includes neuro-oncologists, neurosurgeons, radiation oncologists and interventional radiologists. It also involves a variety of other specialists who offer support services for patients with brain and spine metastasis. They include:
- Pain physicians, who identify nonsurgical approaches to help with pain, especially in patients with spine tumors
- Palliative care specialists, who help patients and their loved ones or caregivers manage symptoms and other issues that impact quality of life
- Physiatrists, who work with patients to improve strength and mobility
- Social workers, who help patients cope with stress and anxiety and offer support
Clinical trials and research
Through clinical trials and research, SCCA, Fred Hutch, and UW Medicine help bring new therapies to clinical practice. These include tucatinib, which received FDA approval in 2020 for the treatment of brain metastases in HER2+ breast cancer.
Researchers lead their own clinical trials and collaborate widely with other groups to participate in studies worldwide. For example, SCCA, Fred Hutch and UW Medicine serve as a clinical site for the Translational Breast Cancer Research Consortium (TBCRC) — one of only two in the western U.S. This collaboration brings high impact clinical trials led by some of the top experts in breast cancer research to the Seattle area.
Current clinical trials and research studies for secondary brain and spine tumors include:
- Tucatinib, trastuzumab, and capecitabine for treating HER2+ leptomeningeal metastases
- Radiotherapy with and without tumor-treating fields for patients with one to 10 brain metastases from non-small cell lung cancer
- Cerebral spinal fluid collection from patients with leptomeningeal metastasis for cell-free DNA analyses to identify targetable mutations that can help identify future therapies
When to refer patients to the brain and spine metastases clinic
Early referral for diagnosis and treatment is essential for brain and spine metastases.
“Neurologic symptoms can often be debilitating and permanent,” says Dr. Venur. “It’s important to plan for those and potentially treat the brain metastases before new symptoms occur. We also have more treatment options when the tumors are smaller and fewer in number.”
Dr. Amin also stresses the importance of assessing cancer patients for spine pain. “About 20% to 30% of patients with cancer will develop spinal column metastases,” he says. “If a patient is complaining of back pain, community oncologists should order an MRI to rule out a spine tumor.”
To contact SCCA’s Brain and Spine Metastases Clinic, call 855.557.0555.
For general patient referrals, contact:
- Phone: 206.606.1062
- Fax: 206.606.5125
- Email: pccneuro@seattlecca.org
- Online referral form
