Living Well With Brain Metastasis

 Doris Schneider at her home in Lumberton, North Carolina (photo by Jared Lazarus)Doris Schneider of Lumberton, North Carolina, had a cough that wouldn’t go away. Doctors diagnosed her with stage 4 lung cancer that had already spread (metastasized) to her brain.

“I was devastated,” Schneider says. “Before I actually got to see an oncologist, the doctors all said, ‘You need to put your life in order.’ I just put my faith in God, trusted my doctors, and leaned on my family and friends.”

In March 2014, doctors at Cape Fear Valley Hospital, near Schneider’s home, used a non-invasive “Cyberknife” procedure to remove the cancer in her brain. Less than a year later, she began having weakness in her left arm and leg. That’s when she was referred to Duke neurosurgeon Peter Fecci, MD, PhD.

Fecci suspected that Schneider’s weakness was caused by tissue damage (necrosis) from the Cyberknife treatment. He scheduled her for a procedure to destroy the damaged tissue, called laser interstitial thermal therapy (LITT). Offered at Duke and a handful of other centers nationwide, LITT uses targeted doses of high heat to treat brain cancer or necrosis, guided by MRI.

Fecci is seeing more and more patients like Schneider. Since he joined Duke as a faculty member two and a half years ago, he has seen his overall surgical volume double, and the number of brain metastasis patients he treats has increased fivefold or sixfold.

Neurosurgeon Peter Fecci used laser interstitial thermal therapy to treat damaged tissue in Doris Schneider's brain. (photo by Jared Lazarus)As recently as ten years ago, patients with brain metastasis were rarely even offered surgical treatment.

“It was essentially viewed as a death sentence,” Fecci says.

But as treatments have improved, these patients have options. “Some of my patients from when I first arrived at Duke two and a half years ago are still doing well,” Fecci says. “A decade ago, that type of survival was just a dream.”

Fecci saw a need for better-coordinated care for these patients. So he started the Duke Brain Metastasis Program, which involves doctors from neurosurgery, medical oncology, radiation oncology, and neuro-oncology.

“Brain metastasis is the kind of problem that requires four or five different specialists to come together,” Fecci says. “These are patients that in a way have been cast aside for a long time, and we’d like to make them a focus instead.”

The program will also offer clinical trials of new therapies especially for these patients.

Brain metastasis patient Doris Schneider at home with her husband, Robert. (photo by Jared Lazarus)Schneider says that Fecci and his nurse practitioner, Denise Lally-Goss, NP, prepared her well for the LITT procedure.

“My husband is a college professor, and I’m a retired teacher, so between the two of us, we asked lots of questions. Dr. Fecci helped me to understand what was going on with my body and what they hoped to do about it, as well as the dangers of brain surgery. I felt at ease.”

She had the LITT procedure one morning and was able to go home the next day.

“I’m just beginning to get back to where I need to be,” Schneider says.

She works in her garden, attends a pulmonary rehabilitation class, and exercises at a fitness center. “If I get tired, I sit down and rest,” she says. “Can I do all the things I used to do before cancer? No. But can I do all the things I need to do for daily life and for happiness? Yes.”

This article originally appeared in the Spring 2017 issue of Breakthroughs, a magazine produced twice yearly by Duke Cancer Institute Office of Development. Subscribe to Breakthroughs. 

Circle photo (top): Peter Fecci, MD, PhD, is an assistant professor of neurosurgery and director of the Brain Tumor Immunotherapy Program and the Brain Metastasis Program. (photo by Jared Lazarus)