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Breast cancer spread to brain

Dear Doctor,

My Mom is a breast cancer patient that has her cancer spread from her breast to neck area and to her brain which she has been treated with a whole head radiation. Additionally, recently she has been infected with shingles on her left face. Her current Oncologist has advise her to proceed with a Cyberknife or gamma knife treatment to her head lesion, but both the Cyberknife and Gamma Knife doctors conclude that by proceeding with the radiation treatment at this stage, we will expose her to risk of lose of vision, motor skill to part of her body and her current quality of life which both doctor recommend to use a chemo or oral medication to treat her brain tumors instead. Additionally both doctor also advice to perform a Head MRI scan every 6 weeks to monitor the activities of the lesion, and in the event the lesion is increasing in sizes rapidly then we should proceed with the radiation treatment.

A recent Pet CT and Head MRI can be email to you for your reference. And her current chemo medication which she is having for about 1 year as follow:

Prescription 3 wk cycle with addition of tykerb:

Biological therapy
1.Avastin: IV 400MG, 100mg per bottle. According to body weight.
2.Melrononie Chemo(oral chemo)

Cyclophosphamide: 50mg. 21 tablets. 1 tablet every am. Oral chemo drug. Before food. Exp 30-6-09. Brand: Endoxan, Baxter Oncology GmbH. 5% strength only.

Methomerate: 2.5mg. 12 tablets. 1 tablet, 2 times a day for 2 days a week. Oral chemo drag. After food. Exp 31-01-2001. 10% Strength only.

Tykerb: 2 in the morning and 2 in the evening, at least ½-1hr before food.

My Questions are:
1)Should we follow the advice of the cyberknife and gammaknife doctor to delay the radiation treatment or should we follow the oncologist advice to treat the brain lesion with radiation now?

2)Should we change her current chemo medication also, as avastin will lead to brain bleeding and she has been on this regime for about 1 year?

3)is it true that since mom has tired so many medication before, avastin at this stage don’t benefit a lot as avastin should be use as a first line of defence?

4)What chemo medication will you use to treat her currently especially her brain tumours? Is termodal a good choice for her head?

5)Is using xeloda and Tykerb suiteable?

6)Judging from her Pet CT scan, what is your opinion of her neck area, her ENT doctor said it could be inflammation?

7)Her current oncologist said that she is very reluctant to give her new chomo because the grow of the tumour is very minimum, is that possible?

7) Kindly advice us of our next course of action.

Thank You very much in advance and your kind advice will be greatly appreciated.
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replied May 2nd, 2010
I wish that I could offer you some helpful advice regarding your mother, but it is best for her Oncologists, who know her very well, to manage her care (and not some anonymous doctor on the Internet).

Based upon your description of her situation, she would appear to be in a very difficult position. If there is a very high risk of blindness or paralysis should she undergo radiation therapy to the brain, then this could be a very high price for her to pay for what sounds like an asymptomatic brain tumor (at least right now).

Unfortunately, once again, I cannot give you any medical advice regarding your mother, except that you should listen very carefully to the advice of her Oncologists.

Sincerely/ Robert A. Wascher, MD, FACS

A landmark, evidence-based guide to a healthy cancer-prevention lifestyle, based on cutting-edge cancer research.
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replied July 2nd, 2011
Wednesday a board of cancer experts recommended the drug Avastin should not be authorized by the FDA for the treatment of cancer. The group determined that the drug has extreme side effects and is unsuccessful. The FDA will rule in July. The proof is here: A panel recommends disapproving breast cancer drug
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