Metastatic Brain or Spine Cancer Treatment

Cancers that Spread to the Brain or Spine
Cancer that starts in one area of the body can metastasize, or spread, to the spine or brain. Cancers that commonly spread to the brain include lung, breast, melanoma, and colon cancers. Cancers that most commonly 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 spine or brain metastases or to slow or halt 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 our patients lead productive lives several 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. 

New Patient Consultations Available Within 72 Hours
Our nurse navigator can also guide you through the process if you are seeking a second opinion for yourself or a loved one.

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.

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

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

Resection Surgery

Whenever possible, we use minimally invasive techniques that require small incisions to remove 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.

Laser Interstitial Thermal Therapy for Brain Tumors and Radiation Necrosis

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. With MRI guiding his or her path, the neurosurgeon makes a 1-centimeter incision in the scalp, then uses a cooled laser probe to deliver a targeted and lethal dose of laser energy directly into the brain tumor. Most patients return home the next day with minimal pain.

Awake Craniotomy for Brain Tumors

A craniotomy requires the removal of a piece of skull to access the brain. When a brain tumor is near an area of the brain that controls a vital function, you may remain awake and pain-free during this procedure so that you can communicate with your surgeon.

Spinal Cord Decompression and Stabilization

This surgical procedure relieves pressure on the spinal cord. Successful decompression of the spinal cord may create adequate space between the tumor and spinal cord to safely receive 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 may 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.

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 spine or brain tumors without the need for incisions. Stereotactic radiosurgery can destroy multiple tumors and, 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

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

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. There are many different types of targeted therapies; some are approved by the FDA. Others are being studied in clinical trials that are open to eligible candidates.

Palliative Care

Palliative care focuses on preventing, managing, and relieving the symptoms of cancer and the side effects of cancer treatment. It helps you and your loved ones address symptoms and clarify goals of treatment along the way. You and your loved ones will be offered the opportunity to meet with a member of our palliative care team.

Rehabilitation Therapy

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

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 several 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.

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 brain tumor research and treatment. That recognition extends to the specialists who treat people with metastatic brain and spine tumors.

Clinical Trial Access
People with brain and spine metastases have historically been excluded from cancer clinical trials. As a Duke patient, you may have the opportunity to participate in studies that are testing medical and radiation advances not yet available elsewhere.

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