Zabi Wardak, M.D. Answers Questions On: Brain Metastases

Typically, patients don’t want to have whole-brain radiation because evidence continues to mount that whole-brain radiation can have untoward side effects.

At UT Southwestern, we have a unique approach in that, when possible, we treat multiple brain metastases aggressively using stereotactic radiosurgery rather than whole-brain radiation. Historically the indication for radiosurgery had been limited but now, thanks to newer technology, we are expanding that criteria.

We are currently investigating increasing the dose of radiation given to brain metastases, particularly larger tumors, in hopes of achieving better control, as these have historically done poorly. We are also looking at the outcomes of patients who are given radiosurgery for a higher than historically treated number of metastases and imaging advancements for the detection of brain metastases.

Gamma Knife is recognized worldwide for treating brain tumors because of its extreme precision. This noninvasive tool (not an actual knife) uses radiation beams from nearly 200 angles to converge on a target, which limits the dose delivered to normal brain tissue. Though it uses cutting-edge technology, the principles and practice of Gamma Knife surgery have been existent since the 1960s, with decades of literature to support its efficacy and safety.

CyberKnife is another advanced tool in our stereotactic suite. The CyberKnife uses both a robotic arm and continuous imaging, allowing us to decrease the radiation “footprint” around the target and spare more healthy tissue. This is particularly important when delivering radiation to tumors near critical structures in the brain.