Duke Center for Brain and Spine Metastasis

The goal of the Duke Center for Brain and Spine Metastasis (DCBSM) is to provide patients with brain or spine metastases rapid access to multi-disciplinary, navigated care and the latest in treatment options.

Patients are guaranteed appointments within 72 hours and can see all the necessary providers (oncologists, radiation oncologists, neurosurgeons, and/or palliative care specialists) on the same day and under one roof.

All patients are assigned to a navigator who knows their treatment goals, coordinates their tests and appointments, and helps see them through their care at Duke. Our care teams communicate daily, and a board of experts meets weekly to review cases. Patients’ goals of care are defined up front and honored at all times. EVERY patient has access to cutting-edge care, technologies, research, and clinical trials. These differences are what make us the leading destination center for patients whose cancer has spread to the brain or spine.

The DCBSM offers state-of-the-art treatment options to patients not only with a new or first-time metastatic cancer diagnosis but also those who may be experiencing progression since previous treatment. Options for all patients can include surgery, stereotactic radiation therapy, chemotherapy, laser interstitial thermal therapy (LITT), targeted therapies, immunotherapy, and more. We also provide access to more than a dozen clinical trials studying the latest advances in treatment and patient care. Many of these trials test therapies and approaches that were developed here and may be available only at Duke.

Importantly, the DCBSM is one of the highest-volume centers in the U.S. for laser interstitial thermal therapy (LITT), a minimally invasive surgical procedure offered at only a handful of U.S. hospitals. This robotic-assisted laser surgical technique is often our preferred approach for recurrent brain metastases; for deeper brain tumors that may be more difficult to remove with open surgery; or for patients with radiation necrosis (an inflammatory condition that can affect certain patients following radiation treatment). LITT procedures are performed in our advanced intra-operative MRI suite, enabling precise targeting of the tumor(s). LITT incisions are generally < 1cm, and patients frequently leave the next morning with just a bandaid for a dressing. The DCBSM continuously aims to lead in the discovery and use of the newest treatments for patients. Cutting-edge research being performed by the world’s thought leaders in cancer is a key component to our success. With help from our researchers, caregivers, and patients, we promise to keep advancing the field and to bring the greatest possible improvements to our patients’ overall survival and quality of life.

A timely and accurate diagnosis, as well as a thoughtful and patient-specific approach, is essential in guiding effective metastatic cancer treatment. Each of these is best accomplished with a multidisciplinary approach, combining the opinions of multiple experts who communicate regularly and can be seen by patients all on the same day. This is exactly what we offer at Duke.

Our highly skilled neuro-radiologists review imaging and provide detailed information about the tumor to our medical oncologists, radiation oncologists, and surgeons. In some cases, a biopsy of the primary cancer may be necessary to confirm and refine the diagnosis of a metastatic brain or spine tumor. Having a complete understanding of a patient’s condition allows our team to begin treatment as quickly as possible.

Once a diagnosis is made, we offer a comprehensive decision-making framework to develop personalized treatment plans consistent with the values and goals of each patient. We customize treatment plans based on the latest literature, neurologic function, oncologic history, the structure and stability of the spine, and the overall extent of the disease. Cases are often reviewed at a weekly tumor board attended by 30-40 caregivers.

Depending on these factors, the treatment team may recommend a combination of therapies to maximize both length and quality of life. Our goal is to provide a personalized, effective treatment plan that maximizes benefits, minimizes risk, and prioritizes patients’ goals.

Brain and Spine Metastatic Cancer Surgery

Duke neurosurgeons use advanced surgical technologies and minimally invasive techniques available only at leading hospitals. This makes it possible for patients who were once deemed inoperable to now be candidates for surgery. These techniques include:

• Awake and asleep brain mapping techniques
• Intra-operative CT and MRI
• Subcortical mapping
• Advanced intra-operative navigation
• High-resolution, 3D Synaptive Bright Matter intra-operative imaging and optics platforms
• Minimally invasive endoscopic and exoscopic surgical options within the brain
• Laser interstitial thermal therapy (LITT), a robotic-assisted laser surgical technique

For spine metastasis, we offer both minimally invasive and open surgical procedures to relieve pain, reduce spinal deformity, improve neurologic function, and restore mobility. These include:

• Vertebroplasty/kyphoplasty/sacroplasty
• Spinal tumor radiofrequency ablation
• Percutaneous instrumentation
• Open surgical intervention
• Spinal cord decompression and stabilization
• Spinal tumor embolization

Plastic surgeons assist in complex back operations and in closing surgical incisions. As experts in wound healing, they frequently employ advanced techniques to reduce complications after spine surgery, such as muscle flaps and negative pressure wound therapy. We offer prophylactic muscle flaps to most patients undergoing spine surgery who are at higher risk for wound-healing problems. This approach leads to a significant reduction in wound healing complications, such as infection, allowing a quicker return to therapies like radiation and chemotherapy.

Radiation Therapy

Stereotactic radiosurgery (SRS) is the gold standard for radiation care when treating brain and/or spinal metastasis, either as a frontline approach or after surgery to eliminate residual microscopic cancer cells. SRS is more specific and generally offers better disease control and fewer side effects than whole-brain radiation therapy (WBRT) or conventional radiation to the brain or spine.

Systemic Therapies

Systemic therapies such as chemotherapy, immunotherapy, targeted therapy, and hormone therapy help control tumor growth, prevent further metastasis, and protect the bones. Several drugs successfully penetrate the blood-brain barrier to deliver treatment directly to the source.

Duke’s Brain Tumor Immunotherapy Program, led by DCBSM Director Peter Fecci, MD, Ph.D., focuses on developing novel, safe, and effective immune-based therapies for brain tumors, both primary and metastatic. Generally regarded as a world leader in immunotherapeutic design, the BTIP has increasingly focused its efforts on creating novel immune-based platforms for the treatment of brain metastases. Working with collaborators that include Nobel Laureates, the BTIP sets Duke apart from other institutions as it works to develop the latest advances to care.

Palliative Care

Palliative care is specialized medical care focused on providing relief from the symptoms, pain, and stress of a serious illness, with the goal of improving quality of life. Research shows that people with cancer have better outcomes when palliative care is part of their treatment. Care is based on the needs of the patient, not on the prognosis. It is appropriate at any age and at any stage of cancer, and it can be provided along with curative treatment.

Bringing together researchers from across Duke and from a wide range of specialties, the multi-disciplinary DCBSM is investigating many aspects of cancer that have spread to the brain or spine, driving research and clinical care towards better treatment and prevention. From studies in cells and animal models to conducting novel clinical trials, dozens of research projects and initiatives are underway to help better understand and treat brain and spine metastasis in a bench-to-bedside (and back) approach.

Our research is focused on a central mission: to lead in discovery and innovation to accelerate the development and adoption of next-generation treatment strategies for brain and spine metastasis. The DCBSM aims to be at the forefront of piloting and implementing novel therapeutics and treatment approaches to improve outcomes and establish new standards of care, survival, and quality of life for patients with brain and spine metastasis.

Focus Areas

Preclinical Models and Drug Testing
We have established a unique facility, the Brain Metastasis Mouse Models “Core” (B3MC), in collaboration with several labs at Duke, to focus on developing promising preventative and treatment strategies for brain metastases. In parallel, the Goodwin lab is focusing on doing the same for spine metastasis.  Both groups are investigating novel treatments for metastases from breast, lung, melanoma, and prostate cancers, as well as others. We have imported tumor models from around the world to provide Duke researchers access to the latest means of studying cancer all here under one roof.  These models enable molecular studies of the biology driving brain and spine metastases, as well as identification and characterization of potential therapeutic targets for rapid translation to the clinic.

Molecular Studies
In collaboration with the Brain Tumor BioRepository (BTBR) in the Preston Robert Tisch Brain Tumor Center, patients can consent to donate excess tissue taken from their brain or spine metastasis during surgery to be used for research studies. Our research efforts include in-depth analysis of patient-donated research specimens to investigate drivers and potential therapeutic targets. Our research team includes leading experts in techniques such as single-cell RNA sequencing and spatial transcriptomics, all part of our new Brain Tumor Omics Program (BTOP), led by Simon Gregory, Ph.D., and Anoop Patel, MD.

Novel and Immune-based Therapies
We are particularly committed to developing effective immune and cell-based therapies against brain and spine metastasis. Duke’s Brain Tumor Immunotherapy Program (BTIP), led by DCBSM Director Peter Fecci, MD, Ph.D., focuses on developing novel, safe, and effective immune-based therapies for brain tumors, both primary and metastatic. Generally regarded as a world leader in immunotherapeutic design, the BTIP has increasingly focused its efforts on creating novel immune-based platforms for the treatment of brain metastases. Working with collaborators that include Nobel Laureates, the BTIP sets Duke apart from other institutions as it works to develop the latest advances to care.