Metastatic Brain or Spine Cancer Treatment

Advanced, Personalized Treatment for Metastatic Brain and Spine Tumors

For More Information 919-681-3038

Experts in the Duke Center for Brain and Spine Metastasis provide care to people whose cancer has spread to the brain or spine. If you have been told your prognosis is poor and your treatment options are limited, we may be able to help. We offer new treatments that may make it possible for you to live longer, with a better quality of life. We focus on your metastatic brain or spine cancer while partnering with your oncologists as they treat your primary cancer.

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Hope When Faced with Metastatic Brain and/or Spine Cancer

Cancers that Spread to the Brain or Spine
Cancer that starts in one area of the body can metastasize, or spread, to the brain or spine. Cancers that commonly spread to the brain include melanoma and lung, breast, and colon cancers. Cancers that most often spread to the spine include lung, breast, and prostate cancer.

Brain or Spine Tumors May Be Difficult to Reach
Depending on the stage, size, and location of the brain or spine tumor, this secondary cancer is typically considered advanced and may be life-threatening. Because these tumors are often difficult to reach, some people are told by doctors elsewhere that their tumors are inoperable and untreatable.

Advanced Treatment Options
We use advances in medical therapy, radiation therapy, and minimally invasive surgery to remove or treat brain or spine metastases or to slow or stop the spread of cancer. Treatments can also lessen symptoms such as pain, seizures, memory problems, trouble speaking, and loss of strength or mobility. Many of the people we treat lead productive lives for years after treatment.

A Patient Navigator Guides Your Care
Our patient navigator guides you and your loved ones through the complexities of receiving cancer care from multiple specialists within our cancer center. Often, more than one appointment can be scheduled on the same day. The patient navigator facilitates your access to the comprehensive support services available at Duke.

Diagnosing Brain and Spine Metastasis

Our first step is to conduct a series of comprehensive exams and tests. Our team reviews your results and uses them to create your personalized treatment plan.

Imaging Scans
MRI, CT, PET, bone scans, and angiography -- accurately pinpoint the location, size, and stage of your brain or spine tumor.

A small sample of your brain or spine tumor may be removed and examined to confirm a diagnosis.

New Patient Consultations Available Within 72 Hours

Our nurse navigator can guide you through the process of seeking a second opinion for yourself or a loved one. Call 919-681-3038.

Surgical Treatments

Resection Surgery for Brain and/or Spine Tumors

Whenever possible, we use minimally invasive techniques and small incisions to remove (or resect) all or part of the tumor. In some cases, open brain surgery may be necessary. Surgery may also be an option for patients whose tumors return after treatment.

Brain Tumor Surgical Options

  • Laser Interstitial Thermal Therapy (LITT): When a brain tumor is difficult to reach or remove through open surgery, this relatively new advance in minimally invasive surgery may be an option. It is also the preferred option for recurrent brain metastases and for radiation necrosis, a complication that can occur after radiation treatment. Using MRI to guide the way, a neurosurgeon makes a tiny incision in the scalp and then uses a laser probe to deliver a strong, targeted dose of laser energy directly into the brain tumor. Most patients return home the next day with minimal pain.
  • Awake Craniotomy: In a craniotomy, a piece of skull is removed to access the brain. When a brain tumor is near an area of the brain that controls a vital function, you may need to remain awake (but unable to feel pain) during this procedure so that you can communicate with your surgeon.

Spine Tumor Surgical Options

  • Spinal Cord Decompression and Stabilization: This procedure relieves pressure on the spinal cord. Successful decompression of the spinal cord may create space between the tumor and the spinal cord for the safe administration of high-dose radiation. If you have significant spinal cord compression or a collapsed vertebra, your surgeon may need to stabilize your spine using rods and screws.
  • Vertebroplasty/Kyphoplasty: When fractured or collapsed vertebrae result from a metastatic spine tumor, a surgical bone cement can be injected into the collapsed vertebra to stabilize the spine. The minimally invasive procedure is intended to relieve pain, reduce spinal deformity, and restore mobility.
Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Nonsurgical Treatments

Stereotactic Radiosurgery

Duke radiation oncologists use stereotactic radiosurgery -- the gold standard of radiation care -- to precisely focus narrow, high-dose radiation beams that destroy difficult-to-reach brain or spine tumors. Stereotactic radiosurgery does not require incisions and can destroy multiple tumors. In some cases, only one treatment session is needed. Careful mapping and planning ensure the radiation targets cancer cells while sparing the healthy tissue, nerves, and blood vessels surrounding the tumor.


Immunotherapy drugs help your immune system identify and attack cancer cells while leaving healthy cells unharmed. Several immunotherapy drugs have already received FDA approval. Others are under investigation and may be available to eligible candidates through clinical trials.


Chemotherapy, given orally or by infusion into a vein, may be prescribed to kill cancer cells after surgery and/or radiation therapy.

Targeted Therapy

This new generation of therapies targets molecules inside your cells that help cancer grow and spread. They block the ways cancer cells multiply while leaving healthy cells alone. Our clinical trials span many types and aspects of brain and spine metastasis and study many different types of targeted therapies. Some therapies are approved by the FDA. Others are being studied in new and unique trials that are open to eligible candidates.

Palliative Care

You and your loved ones will be offered the opportunity to meet with a member of our palliative care team. Palliative care focuses on preventing, managing, and relieving the symptoms of cancer and the side effects of cancer treatment. With services including pain management, symptom management, psychosocial support, and spiritual care, we help you and your loved ones clarify goals of treatment along the way. Research shows that people with cancer have better outcomes when supportive care is a regular part of treatment.

Rehabilitation Therapy

Rehabilitation will be an important part of your recovery. Our physical therapistsoccupational therapists, and speech pathologists can help you strengthen your muscles, improve your mobility, speak more clearly, or learn easier ways to perform everyday tasks.

Why Choose Duke

The Duke Cancer Institute
The Duke Cancer Institute brings together the extensive resources of Duke University, Duke Health, and the Duke Comprehensive Cancer Center. We are committed to making innovative discoveries, developing new ways to prevent, diagnose, and treat cancer, and delivering those therapies in a patient- and family-centric way.

Our Focus Is Brain and Spine Metastasis
Our neurosurgeons, spine surgeons, radiation oncologists, medical oncologists, pathologists, radiologists, pain management specialists, palliative care specialists, and other providers meet weekly to create treatment plans for our patients. This team approach means a team of specialists contribute their expertise to your care.

Close Collaboration with Your Oncologist
People come to Duke from across the country for the treatment advances we offer. Whether you live close by or far away, we work with your oncologist so any treatments you receive at Duke will supplement your ongoing cancer care.

Clinical Trial Access
People with brain and spine metastases have historically been excluded from cancer clinical trials. The Duke Center for Brain and Spine Metastasis (DCBSM) is one of the only research programs of its kind. We develop trials that are specifically geared toward brain and spine metastases, molecular alterations of the metastasis, treatment side effects, quality of life, and more. As a Duke patient, you may have the opportunity to participate in studies that are testing medical and radiation advances not yet available elsewhere.

Planning and Navigation Tools Ensure Surgical Accuracy
Our advanced technology helps make brain and spine surgery safer and more effective. For example, our surgeons use “tractography” to visualize the complex wiring within the brain at the highest resolution possible. They use this technology to create a path to your tumor that avoids critical structures involved in language, memory, and motor control. Likewise, intraoperative MRI gives your surgeon detailed images of your brain or spine during surgery, to ensure they remove as much of the tumor as possible.

Leaders and Teachers
Duke doctors and surgeons are among a handful of specialists in the country who are refining, performing, and teaching new treatments for brain and spine metastases. Our team includes leaders in studying the benefits of using stereotactic radiosurgery instead of whole-brain radiation. And our neurosurgeons train their peers at other centers in how to perform laser interstitial thermal therapy.

Nationally Recognized Brain Tumor Program
Our experts are at the forefront of primary brain tumor research and treatment, and this extends to caring for individuals with metastatic brain and spine tumors. Our team is renowned for expertise in managing and supporting people with metastatic brain and spine tumors.

Ongoing Research Leads to New Developments
Some of our ongoing research focuses on brain and spine tumor immunobiology. We’re working to create immune-based therapies such as vaccines that will train the immune system to fight brain and spine metastases as if they were infections.

Best Cancer Hospital in North Carolina

Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

This page was medically reviewed on 09/13/2023 by