Episode 013: Heme/Onc Emergencies, Pt. 2: Brain Mets
Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further.
In this episode, we talk all about our second oncologic emergency: new brain mets
Brain mets:
Strongly consider steroids, particularly with the presence of vasogenic edema associated with brain mets
Stereotactic radiosurgery (SRS): use of high dose radiation delivered in a single treatment (“fraction”) that is delivered focally to the area of disease seen on imaging (typically MRI); great option for brain mets; can be performed by radiation oncology
What to do to expedite Rad Onc planning:
Thin-cut MRI
Start patient on steroids
Interpreting MRI imaging:
T1 post-contrast sequence: to look for brain mass
T2 sequence: looking for vasogenic edema surrounding brain mass
Midline shift is an issue more so when it is acute; this is very different than slow changes over time
Who to operate on? Functional status prior to surgery; not in an area that can cause other harm; no other good alternative treatment options
What to tell your NSGY colleague during a consult:
A quick neuro exam (consciousness, strength, sensation, focal neurologic issues)
Brief cancer history
Underlying organ dysfunction
Antiplatelet/anticoagulants
A HUGE thank you to our special guests:
Ryan Miller, MD, MS: PGY5 in Radiation Oncology at Thomas Jefferson University Hospital, Philadelphia, PA
Joshua Lowenstein, MD, MBA: Neurosurgery Attending, REX Neurosurgery and Spine Specialists, Raleigh, NC
