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

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