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Metastatic Brain Tumors

‘Metastasize’ means to spread, grow or change form. In pathology (the science of disease), ‘metastasize’ describes the spread of cancer cells from the primary site of the disease to other parts of the body.  From primary sites such as the lungs, breasts, kidneys, bladder or skin, tumor cells can spread via the circulatory system (or, in the case of leukemia and lymphoma, can originate within it) to the brain.

Metastatic brain tumors (also referred to as brain metastases, secondary brain tumors or metastasis to the brain) are the most common type of brain tumor in adults. The majority of them are discovered after the primary cancer has already been diagnosed, when a cancer patient first experiences neurological symptoms and undergoes a CT or MRI scan. In rarer cases, a person with neurological symptoms (or requiring imaging for other medical reasons) and no history of cancer may undergo a brain scan that leads to the discovery of brain metastases. Over 80% of metastatic brain tumors arise as multiple lesions in the brain (with fewer than 20% manifesting as a single tumor), and over 80% of all lesions appear in the cerebrum (the uppermost, largest, most recently evolved part of the brain that receives the majority of blood flow).

The signs and symptoms of metastatic brain tumors are the same as any expanding intracranial (within the skull) lesion. They result from the pressure the metastases put on the surrounding tissue, from edema (fluid-based swelling) or from hemorrhage (bleeding). Symptoms vary based on the location of the tumor within the brain and include headaches, seizures, cognitive difficulties (loss of memory or changes in personality or behavior), weakness in an area of the body, decreased coordination or issues with vision, numbness, tingling or other sensation.

As cancer therapies have improved, an increasing number of cancer patients are living longer. Unfortunately, increased patient life expectancy gives cancer cells greater opportunity to spread from their primary sites, causing the incidence of metastatic brain tumors to rise as well. Thus, techniques for treating intracranial tumors, such as Gamma Knife radiosurgery, are vital components of the fight against cancer. Utilized by doctors at the Boston Gamma Knife Center at Tufts Medical Center to limit the growth of small or delicately situated metastases, Gamma Knife radiosurgery isn’t traditional surgery—no incisions are made. Instead, this state-of-the-art technology focuses 192 beamlets of gamma radiation on the tumor, delivering a high dosage at the site of convergence while saving the vital surrounding tissue from radiation’s harmful effects.

Doctors + Care Team

Carl B. Heilman, MD

Carl B. Heilman, MD

Title(s): Neurosurgeon-in-Chief; Chairman of Neurosurgery; Professor, Tufts University School of Medicine
Department(s): Neurosurgery
Appt. Phone: 617-636-5860
Fax #: 617-636-7587

Meningiomas, acoustic neuromas, skull base surgery, pituitary surgery, Chiari surgery

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John E. Mignano, MD, PhD

John E. Mignano, MD, PhD

Title(s): Radiation Oncologist; Clinic Director; Associate Professor, Tufts University School of Medicine
Department(s): Radiation Oncology, Pediatric Radiation Oncology
Appt. Phone: 617-636-6161
Fax #: 617-636-4513

Oncologic consultation for general radiotherapy and Gamma Knife, pediatric radiation oncology

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Julian K. Wu, MD

Julian K. Wu, MD

Title(s): Associate Chairman, Department of Neurosurgery; Chief, Division of Neurosurgical Oncology; Neurosurgery Residency Program Director; Professor, Tufts University School of Medicine
Department(s): Neurosurgery
Appt. Phone: 617-636-4500
Fax #: 617-636-7587

Neuro-oncology, Gamma Knife radiosurgery, meningiomas, pituitary tumors, gliomas, brain metastasis, trigeminal neuralgia

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Mina Safain, MD

Mina Safain, MD

Title(s): Neurosurgeon; Assistant Professor, Tufts University School of Medicine
Department(s): Neurosurgery
Appt. Phone: 617-636-5860
Fax #: 617-636-7587

Pituitary tumors, brain tumors, meningiomas, minimally invasive spine surgery, complex and reconstructive spine surgery, spinal microsurgery, spinal trauma

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Suriya Jeyapalan, MD, MPH

Suriya Jeyapalan, MD, MPH

Title(s): Neuro-Oncologist
Department(s): Neurology; Cancer Center
Appt. Phone:
Neurology: 617-636-5848
Hematology/Oncology: 617-636-6227
Fax #: 617-636-8199

Neuro-oncology, brain tumors, neurologic metastases

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Research + Clinical Trials


METIS: Pivotal, open-label, randomized study of radiosurgery with or without Tumor Treating Fields (TTFields) for 1-10 brain metastases from non-small cell lung cancer (NSCLC).

The study is a prospective, randomized controlled phase III trial, to test the efficacy, safety and neurocognitive outcomes of advanced NSCLC patients, following stereotactic radiosurgery (SRS) for 1-10 brain metastases, treated with NovoTTF-100M compared to supportive treatment alone. The device is an experimental, portable, battery operated device for chronic administration of alternating electric fields (termed TTFields or TTF) to the region of the malignant tumor, by means of surface, insulated electrode arrays.
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Evaluating the Expression Levels of MicroRNA-10B in Patients with Primary Gliomas

MicroRNAs (miRNA) are molecular biomarkers that post-transcriptionally control target genes. Deregulated miRNA expression has been observed in diverse cancers. In high grade gliomas, known as glioblastomas, the investigators have identified an oncogenic miRNA, miRNA-10b (mir-10b) that is expressed at higher levels in glioblastomas than in normal brain tissue. This study tests the hypothesis that in primary glioma samples mir-10b expression patterns will serve as a prognostic and diagnostic marker. This study will also characterize the phenotypic and genotypic diversity of glioma subclasses. Furthermore, considering the critical function of anti-mir-10b in blocking established glioblastoma growth, the investigators will test in vitro the sensitivity of individual primary tumors to anti-mir-10b treatment. Tumor, blood and when feasible, cerebrospinal fluid samples will be obtained from patients diagnosed with Grade III and Grade IV gliomas over a period of two years. These samples will be examined for mir-10b expression levels. Patient survival, as well as tumor grade and genotypic variations will be correlated to mir-10b expression levels.
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A221101: A Phase III Randomized, Double-Blind Placebo Controlled Study of Armodafinil (Nuvigil®) To Reduce Cancer-Related Fatigue in Patients with High Grade Glioma

The purpose of this study is to:  1) see if taking the study agent, armodafinil, at a dose of 150mg or 250mg, will improve problems with fatigue in subjects who have been diagnosed with cancer and are experiencing fatigue; and 2) see the effects (good and bad) of taking Armodafinil compared to placebo (an inactive agent) on cancer related fatigue. In this study, subjects will take either the study agent, armodafinil, or the placebo (inactive agent).  Subjects will not take both. Armodafinil (Nuvigil®) is a medicine that is currently FDA approved to promote wakefulness in people who have sleep disorders.   However, it is not been studied in people with cancer related fatigue.
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