Brain and Spine Metastases

Cancer in the breast, lung, colon, skin, kidney, thyroid, or elsewhere in the body can metastasize, or spread, to the spine or brain. 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 patients are told by doctors elsewhere that their tumors are inoperable and untreatable.

A Team of Highly Experienced Specialists
Duke’s team of neurosurgeons, radiation oncologists, and medical oncologists aggressively treats hundreds of people each year with brain and spine metastases. We work with people who are seeking a diagnosis or a second opinion. We focus on your metastases while partnering with your oncologists as they treat your primary cancer.

Advanced Treatment Options Slow Cancer Progression, Ease Side Effects
We use advances in medical therapy, radiation therapy, and minimally invasive surgical laser procedures 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 patients and their loved ones through the complexities of receiving cancer care from multiple specialists within our cancer center. She ensures timely access to treatment and facilitates your access to the comprehensive support services available at Duke.

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. 

Neurological Exam

A complete neurological exam may include tests of your balance, strength, sensation, coordination, reflexes, vision, swallowing, and ability to think and remember.

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 to confirm a diagnosis. 

Spinal Tap

If a spine tumor is present, a small sample of spinal fluid may be removed for examination under a microscope.

One or more of the following treatments may be part of your personalized treatment plan. 

Radiation Therapy

Radiation therapy uses high-energy beams to destroy cancer cells. Careful mapping and planning ensures the radiation targets cancer cells while sparing the healthy tissue, nerves, and blood vessels surrounding the tumor

Stereotactic Radiosurgery

Stereotactic radiosurgery is considered the gold standard of care for brain and spine metastases. Duke radiation oncologists use advanced techniques to precisely focus powerful radiation beams that destroy difficult-to-reach spine or brain tumors, without the need for incisions. Radiosurgery can destroy multiple tumors and, in some cases, only one treatment session is needed.

Brain or Spinal Surgery

Surgery may be performed to remove all or part of the brain or spine tumor. Whenever possible, we use minimally invasive options that require small incisions. In some cases, open brain surgery may be necessary. MRI imaging during surgery may be used to ensure accuracy and precision when needed. Surgery may also be an option for patients whose tumors return after treatment.

Laser Interstitial Thermal Therapy

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 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.

Chemotherapy

Oral drugs or injections may be prescribed to kill cancer cells after surgery or radiation therapy. 

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. 

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.

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 Metastases
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.

New Patient Consultations Available Within 72 Hours
We see you quickly and respect your time while you’re here. Our patient navigator coordinates your appointments so you see multiple specialists on the same day.

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 thought leaders on 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.

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.