Treatment of Brain Metastases in Germany
Best hospitals and doctors for brain metastases treatment in Germany
Leading hospitals
Cost for treatment
Metastatic brain lesions develop at the advanced stage of cancer. In a country with poorly designed medicine, the presence of such metastases is a sentence. However, it is just an excuse for the additional medical processes. Cancer cases with brain metastases are that are still curable, while a cure can control others for years. Doctors in Germany remove metastatic brain tumors with surgical techniques, destroy them with radiation therapy and suppress them with medicines. If you want to get good treatment results, you can undergo cancer treatment in one of the Germany hospitals, with the world's best oncologists.
Content
- Principles of treatment
- Surgical treatment
- Radiation therapy
- Systemic therapy
- How to undergo treatment in Germany
Principles of treatment
The treatment for brain metastases is selected individually. It depends on where the tumor has metastasized to the brain from, its aggressiveness, how extensive the metastases are, how many of them are there, in what parts of the brain they are located, whether the patient has undergone surgery or radiation therapy in the past, whether there are metastases in other organs, whether there is intracranial hypertension ETC.
The main treatment options for patients with the diagnosed brain metastases are as follows:
- surgery;
- stereotactic radiation therapy;
- drug therapy (preference is given to the drugs that can penetrate the blood-brain barrier).
Surgical treatment
A neurosurgical intervention to remove metastases is the preferred treatment option for the patients:
- with a good control of the primary tumor or after its surgical removal;
- without severe comorbidities;
- with a size of neoplasms more than 3 cm;
- with symptomatic tumors;
- with intracranial hypertension.
The surgical intervention instantly eliminates or relieves neurological symptoms, normalizes cerebrospinal fluid outflow, increases life expectancy, and reduces the need for steroids. In addition, it creates good conditions for subsequent drug therapy.
The surgical interventions performed at the Germany hospitals are very effective not only due to the professionalism of doctors but also thanks to the state-of-the-art equipment. Neurosurgeons use the latest imaging systems: preoperative functional MRI, intraoperative neuronavigation, and cortical mapping. These procedures provide:
- minimal risk of the residual tumor (incomplete removal);
- low probability of developing complications associated with damage to functionally significant brain structures.
Doctors in Germany Perform complex combined operations to simultaneously remove a primary tumor and metastatic neoplasms in the brain. For example, one team of surgeons can deduct a part of the intestine affected by a malignant process, and a group of neurosurgeons at the same time perform resection of metastatic foci in the brain.
The opportunities for surgical treatment are limited for multiple tumors. Nonetheless, in Germany, many metastases are considered only a relative but not an absolute contraindication to surgery. Many patients are operated on. FIRST, the surgical intervention is performed for those who have developed intracranial hypertension due to the tumor process. a single surgical approach can remove all tumors, and patients can receive surgical treatment. When assessing the prospects for surgery, doctors consider the number, the size, and the location of tumors: how accessible they are for the removal. suppose the potential benefits of surgery outweigh the risks. In that case, doctors perform the operation that, if successful, eliminates most of the symptoms and gives the person many more years of active life.
Doctors in Germany successfully deal with treating recurrences of brain metastases that repeatedly develop after surgical removal. The candidates for such an operation are patients with good control of all other tumor foci. If the tumor is non-aggressive, the general health condition allows for surgical intervention, and the time to recurrence exceeds four (4)months. most often, young patients under the age of 40 with single brain metastasis are operated on.
Radiation therapy
Irradiation is one of the main methods of treatment in oncology. This is the most commonly used method of controlling the tumor process with brain metastases. Radiation therapy is used both after surgery and as an independent treatment method.
Postoperative radiation therapy
If only the surgical intervention is performed to remove metastases, then the probability of its development in the same site within 12 months is 60%. Additional radiation therapy after the surgery may reduce the risk of tumor recurrence up to 28%.
The healthcare facilities in Germany use stereotactic radiosurgery. This is a modern way to deliver high-dose radiation accurately. The radiotherapy method minimizes the exposure of normal brain tissues, thereby reducing the risk of developing neurological complications compared to conventional radiation therapy. Doctors in Germany use state-of-the-art linear accelerators with a frameless stereotaxis – the specialists do not have to screw a rigid frame to the patient's skull. The necessary dose of radiation is delivered from different directions. The devices used in the Germany hospitals are so precise that they allow radiation exposure only within a single session (single-fraction radiotherapy or radiosurgery).
Radiation therapy without surgery
If the patient is considered an unsuitable candidate for surgical treatment, they may undergo radiation therapy.
Small brain metastases, especially those with clear boundaries, are an ideal target for radiosurgery – the tumor destruction only within a single session. High doses of radiation during radiotherapy for large tumors or tumors located close to the critical nervous structures are associated with a significant risk of complications. Such patients require several sessions, but there will be a minimum number of them in any case. The equipment used in German oncology departments makes it possible to destroy brain neoplasms within 2-to 7 sessions.
Radiosurgery provides a high treatment efficiency comparable to surgery. When the number of metastases is not more than 3, 90% of patients have a good effect. The tumors disappear, shrink, or stop growing. Better survival rates are characterized by fewer metastases. People with a single metastasis live an average of 70% longer than people with three metastases. The treatment outcomes depend on the size and the number. They do not rely on the patient's age: clinical trials have shown that the response rate to cancer treatment in people over 80 years of age is the same as in younger patients.
At the same time, radiation therapy has disadvantages compared to surgery. The tumors do not disappear instantly after their physical removal but are destroyed gradually. They may not disappear but only shrink. In addition, in some patients, neoplasms do not shrink but only stabilize in size. This means that if there are cerebrospinal fluid outflow disorders or severe neurological symptoms, they are unlikely to disappear shortly even after the suppression of cancer by radiation. Therefore, radiotherapy and radiosurgery are preferred in patients who do not suffer from severe symptoms. If there are pronounced neurological manifestations of cancer, neurosurgical treatment is preferable.
Another problem is the radioresistance of some types of cancer. For example, only a small number of patients with melanoma or renal cell carcinoma respond to radiotherapy. surgery or drug therapy for cancer is the preferred treatment for these patients if the neurosurgical intervention is contraindicated.
In the last few years, due to the improvement of medical technology, the oncology departments at the Germany hospitals are increasingly performing radiosurgery on patients with multiple brain metastases. The treatment method is effective and safe even in a dozen metastases. When making CRITICAL decisions regarding the treatment options, doctors are guided not by the number but by the total volume of metastases. The clinical trials have shown that their number does not significantly affect the prognosis. Large numbers of cancer metastases diagnosed can achieve good treatment results if they are small.
Patients tolerate radiation therapy. Side effects are observed in the first two (2) weeks after the brain irradiation. These may be nausea and headache. Depending on the size of the tumors and the equipment used, the risk of complications ranges from 10 to 40%, but severe complications are infrequent. Steroids can eliminate most side effects and complications
Germany hospitals use not only photon radiotherapy but also proton one. This is an innovative way to irradiate tumors with an even lower risk of complications. Protons, unlike photons, emit most of the radiation only inside the target and almost do not irradiate the tissue through which they pass. As a result, doctors can reduce the radiation exposure to the healthy tissue or safely increase the radiation dose to destroy even radio-resistant tumors. There are six proton therapy centers in Germany, which is more than in any other country in Europe.
Systemic therapy
In oncology, systemic therapy is almost always used for the advanced stage of cancer, in which distant metastases develop. Systemic methods, unlike local ones, act immediately on all tumor foci.
The problem with chemotherapy for cancer with brain metastases is that most drugs do not penetrate the blood-brain barrier well. It separates the body's blood circulation from the cerebral circulation to prevent the entry of microorganisms, toxins, immune factors, etc. But it also prevents drugs from suppressing the development of cancer in the brain.
This problem has been successfully solved in Germany. Doctors use medications that can cross the blood-brain barrier. Thus, doctors conduct not only chemotherapy, but also targeted therapy. It is selected individually, depending on the type of cancer and the presence of mutations in the tumor.
Melanoma. Approximately 11% of cases of brain metastases are associated with this disease. The condition is treated with BRAF and MEK inhibitors. A real revolution in the treatment of such patients took place after the introduction of immune checkpoint inhibitors. Their use allows achieving a response to treatment (tumor shrinkage or disappearance) in 55% of patients. The percentage of success is even higher if we consider the cases of tumor growth stabilization.
Non-small cell lung cancer. This condition is the cause of 50% of brain metastases. The disease is treated with new generation tyrosine kinase inhibitors safer than their predecessors and more effective. These drugs are used in the presence of the ALK gene mutations. Doctors also use drugs that are effective against the EGFR gene mutations. In people with PD-L1-positive cancer, immune checkpoint inhibitor therapy is effective. Approximately half of the patients can receive such treatment. The treatment is selected individually, according to the results of molecular genetic diagnostics.
Breast cancer. Most cases of this type of cancer are successfully treated before metastases occur, but some cancers are more aggressive. With triple-negative cancer, the risk of the development of brain metastases reaches 50%, with HER2-positive, this indicator accounts for 30%. When dealing with the treatment of such patients, doctors in Germany use not only chemotherapy and "ordinary" monoclonal antibodies, but also antibody-drug conjugates, which provide a better penetration of drugs into the cancer cells through the blood-brain barrier.
How to undergo treatment in Germany
To undergo the treatment for brain metastases by the best doctors globally, you are welcome to use the booking health service. on our website, you have the opportunity to get up-to-date and accurate information about the cost of treatment in Germany, compare prices in different German hospitals and book a medical care program at the best price. The treatment in Germany will be easier and faster for you, and the cost of treatment in Germany will be lower.
Please leave your request on the website of the medical tourism agency Booking Health. Our employee will contact you, provide advice and answer all your questions. We will take care of the organization of your trip. We will provide the following benefits for you:
- We will select a hospital and an oncology department in the German hospital whose doctors specialize in treating metastatic brain cancer and achieving the best results.
- We will help overcome the language barrier and establish communication with the doctor at the German hospital.
- You will receive medical care on the most suitable dates, and this will reduce the waiting period for treatment in Germany.
- We will reduce the price. The cost of treatment in Germany will be lower than usual. Eliminating overpricing and additional coefficients for foreign patients will reduce it.
- Our specialists will solve any organizational issues: paperwork, transfer from the airport to the German hospital and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You do not have to repeat the previously performed diagnostic procedures.
- We will keep in touch with the German hospital after completing treatment in Germany.
- If necessary, we will organize additional treatment in Germany, diagnostics, or rehabilitation.
- We will buy medicines in Germany and forward them to your native country.
While the best specialists in the world are taking care of your health, the Booking Health staff will help to reduce the cost of treatment in Germany and take care of all your travel arrangements.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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