Treatment Advances Give Hope to People with Brain Metastasis

By Erin Hull
June 08, 2018
A couple outside their home

Dave and Lisa VanTress stand outside their home in Little River, SC.

Lisa VanTress didn’t know why she couldn’t regain her land legs after a 13-hour fishing trip in the summer of 2016. When the dizziness caused her to stumble and fall, she went to the emergency room. She soon learned she had lung cancer that had spread to her brain.

A Grim Prognosis, Hope from a Second Opinion

Doctors near her home in Little River, SC, gave VanTress a grim prognosis. They said the two masses in her brain were inoperable.

VanTress sought a second opinion with DukeHealth neurosurgeon Peter Fecci, MD, PhD. She and her husband, Dave, are glad they did.

“If she hadn’t come here and she had gone home, there’s no doubt that she’d be dead by now,” said Dr. Fecci, co-director of the Duke Center for Brain and Spine Metastasis. “People still have traditional, old-school attitudes toward these tumors and think they can’t be treated. That’s just not true anymore.”

“I took a look and said, this is a difficult situation but it is something that we can operate on and it’s something that we can treat,” he said.

A Team Approach to Treating Brain and Spine Metastasis

Cancer that has spread to the brain from another site -- in VanTress’ case, lung cancer -- is called brain metastasis. Brain metastasis are often more difficult to treat with chemotherapy and immunotherapies, medications that typically work on other cancers but can’t effectively penetrate the brain or kill cancers located there, Dr. Fecci explained.

“The brain does a very good job of keeping things out, which is great for you on a daily basis but not so great when you need a drug to get in there,” he said.

Effective brain metastasis treatment requires advanced neurosurgical techniques and radiation therapies. The Duke Center for Brain and Spine Metastasis has highly skilled neurosurgeons, radiation oncologists, and medical oncologists who work closely together to create personalized plans that address the specific needs of each individual they treat.

No Further Signs of Cancer Spread

Dr. Fecci successfully removed VanTress’ two brain tumors. Her surgery was followed by stereotactic radiosurgery, which accurately delivers radiation to the area surrounding where the tumors were removed while minimizing damage to healthy tissue. It was performed under the guidance of radiation oncologist Scott Floyd, MD, PhD.

Once the brain tumors were removed, Duke medical oncologist Jeffrey Clarke, MD, started VanTress on a treatment plan for the lung cancer that remained. The lung cancer spots have started to shrink, and a recent CT scan shows no sign of the cancer spreading further.

Images of Lisa's brain before and after surgery
Dr. Fecci successfully removed both tumors from Lisa's brain in a single surgery.

Duke Offers Options to People with Brain Metastasis

VanTress firmly believes she wouldn’t be here today “if I had had a different doctor, besides Dr. Fecci and his crew.”

While that may be true, Dr. Fecci said her case and outcome is typical among the patients he sees at Duke.

“I think most people that come here will find that we have options,” he said.