Radiation Treatment for Breast Cancer Metastasis
- Actress Shannen Doherty’s breast cancer has spread to her brain and she is receiving radiation treatment. Concerned fans wonder what this means for her.
- Showing an intimate look into her cancer journey takes strength. Doherty has been determined to show what brave cancer warriors go through. It’s clear she’s facing her disease with everything she’s got.
- There is no cure for stage 4 (metastatic) breast cancer, but treatments available are helping to prolong the lives of patients and improve quality of life.
- “Radiation therapy is common for managing diseases that spread to the brain. Patients have a lot of options today for the way the radiation is given, and patients and doctors choose which type of radiation treatment they use,” Dr. James Taylor tells SurvivorNet.
- We don’t know what type of radiotherapy Doherty is receiving, but one option includes stereotactic radiosurgery, in which beams are precisely focused on the tumor with little impact on healthy tissue.
- Prognosis after brain metastasis depends on the individual patient and the prevalence of the disease, Dr. Taylor said, but it generally remains “poor,” according to the Moffitt Cancer Center.
“The outlook for any patient with stage 4 cancer is very complex and difficult to assess,” radiation oncologist Dr. James Taylor of GensisCare tells SurvivorNet.
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Doherty was first diagnosed with breast cancer in 2015. It went into remission in 2017 but returned as stage 4 (or metastatic) in 2019. Metastatic cancer, for which there is no cure, means it has spread to distant areas of the body, like the bones, liver, lungs, or brain.
Dr. Taylor explains that stage 4 cancer patients undergoing radiation treatment must be assessed on an “individualized basis.” He added that their prognosis depends on the prevalence of the disease in and outside the brain.
Generally, treatment for brain metastasis for many patients is “focused on slowing the growth of the malignancy (cancer) and relieving the resulting symptoms,” according to the Moffitt Cancer Center.
Overall, according to researchers published in the journal Cancers, "the prognosis after brain metastasis remains poor” for patients because of how difficult it is for medicine to reach the brain (more on that below).
It’s important for other stage 4 breast cancer patients to remember that what Shannen Doherty is experiencing is not necessarily what every person with stage 4 breast cancer experiences, and only 10-15% of women with stage 4 breast cancer" may experience brain metastasis, says Dr. Eleanora Teplinsky.
Dr. Teplinsky is the head of breast and gynecologic medical oncology at Valley Health System. She's also a clinical assistant professor of medicine at Icahn School of Medicine at Mount Sinai.
Doherty had initially undergone hormone therapy, a single mastectomy (the removal of all breast tissue from one breast), chemotherapy, and radiation after her 2015 diagnosis. It’s unclear what her treatment has looked like in recent years.
"My fear is obvious," Doherty wrote on Instagram when she revealed her brain metastasis.
“The turmoil….. the timing of it all…. This is what cancer can look like."
Doherty revealed earlier this year that she is also in the middle of divorcing her husband after 11 years of marriage.
Showing such an intimate look into her ongoing cancer journey takes so much courage and strength. Doherty has been determined to show first-hand what brave cancer warriors endure and overcome. And it’s clear she is facing her disease with everything she’s got.
Doherty, like all patients receiving radiation to the head or neck area, must wear a plastic, mesh-like mask to keep her head in the proper place during the procedure. It is placed over her face and is secured to the machine table.
Doherty admitted the mask and radiation treatment aren't exactly comfortable – something so many patients can relate to. She said she is “extremely claustrophobic.”
Tears fell from Doherty’s eyes during the procedure when she was having the mask fit to her head.
Out of sensitivity for Doherty and our readers, we have decided not to include the emotional videos here in our story. But you can view them on Doherty's Instagram page here if you wish to watch them.
Claustrophobia, or the fear of tight places, and anxiety are common feelings for radiation patients, and experts recommend bringing music or a podcast to listen to help you relax.
Be sure to ask your individual care team beforehand if this is allowed.
For patients undergoing radiation therapy who become uneasy, Dr. Taylor says there are ways to cope.
“The room you’re being treated in is very open so if the mask doesn’t bother you, you’ll be fine. If the mask bothers you because of its tight fit, I tell my patients, the tighter the mask is, the safer the treatment. If you’re claustrophobic, just tell your medical team because we have medications to put you at ease,” Dr. Taylor explained.
It’s important for other stage 4 breast cancer patients to remember, what Shannen Doherty is experiencing is not necessarily what every person experiences according to oncologists who spoke with SurvivorNet.
WATCH: Treatment Options for Late-Stage Breast Cancer
What Is Breast Cancer Brain Metastasis?
"Any cancer can spread to the brain," according to Mayo Clinic. Once in the brain, it can form one or many tumors. Cancers more likely to metastasize to the brain include lung, breast, colon, kidney and melanoma.
The Moffitt Cancer Center says brain metastasis and brain cancer are not the same.
"The distinction between brain cancer and brain metastasis lies in where the cancer originated brain cancer involves tumors made up of cancerous brain cells, while brain metastasis involves tumors made up of cancerous cells from elsewhere in the body."
Whether breast cancer is likely to spread to the brain can depend on the cancer subtype, Dr. Teplinsky said.
“We tend to see it more with triple-negative breast cancer or HER2-positive breast cancer but it varies,” Dr. Teplinsky explained.
Women with the breast cancer subtype HER2-positive breast cancer have high levels of the HER2 protein on the outside of their cancer cells.
Triple-negative breast cancer means the person’s cancer is not being fueled by any of the three main types of receptors estrogen, progesterone and the HER2 protein. Without these receptors, the cancer won't respond to certain hormone therapies or treatments that target them.
Other risk factors for breast cancer brain metastasis include younger age (especially being younger than 35 at diagnosis), having a breast tumor larger than 2 cm, and having cancer in the lymph nodes and the time of diagnosis.
Still, it’s important to remember that just because you may fall into one of these categories does not necessarily mean that your cancer will definitely spread to the brain.
Dr. Teplinsky tells SurvivorNet women battling stage 4 breast cancer should be on the lookout for symptoms associated with spreading to the brain.
“If people have symptoms that include dizziness, vision changes, feeling off balance, and confusion, talk to your doctor. The symptoms can look different for everyone,” Dr. Teplinsky explained.
Expert Resources on Radiation Therapy
Radiation Therapy When Breast Cancer Spreads to the Brain
While there is no cure for metastatic breast cancer, treatments are available to help prolong the lives of patients and help improve quality of life. Radiation therapy, like what Shannen Doherty is receiving, is one of the treatment options.
“Developing metastasis in the brain is common. Traditional agents like chemotherapy and targeted therapy treatment have limited access to the brain,” Dr. Taylor explains due to the blood-brain barrier (BBB).
The blood-brain barrier is a “network of blood vessels and tissue that is made up of closely spaced cells and helps keep harmful substances from reaching the brain,” the National Cancer Institute describes. It is because of this barrier that cancer drugs like chemotherapies have a difficult time reaching cancer cells in the brain.
“Radiation therapy is common for managing diseases that spread to the brain. Patients have a lot of options today for the way the radiation is given, and patients and doctors choose which type of radiation treatment they use,” Dr. Taylor added.
Research published in Cancers suggests that treatments for breast cancer brain metastasis are becoming less invasive and allows patients to retain their cognitive abilities and overall quality of life.
WACH: Coping With Difficult Emotions During Cancer
The Side Effects Does Radiation Therapy
While radiation therapy shows promise for cancer patients battling the disease, it may come with side effects.
“Side effects someone might expect are dependent on the type of radiation they get. It may be very few if the patient is receiving stereotactic radiosurgery for example.,” Dr. Taylor explained.
In stereotactic radiosurgery, doctors precisely focus the radiation beams on the tumor with little impact on health tissue. It is not surgery in which an incision is made. Dr. Taylor describes this procedure as painless with minimal side effects.
On the other hand, whole-brain radiation treatment applies radiation to the entire brain to kill tumor cells. While the patient does not experience immediate side effects, long-term symptoms they can experience may include memory problems and other executive functioning issues.
Other side effects of radiation to the brain may include:
- Fatigue
- Appetite loss
- Hair loss
- Headaches
- Nausea
The specific side effects people experience may depend on the person's age and health, the radiation dose used, and the size and location of the area targeted.
Talk to your doctor if you experience any of these side effects from radiation treatment, as they may have ways to help manage them.
Questions for Your Doctor
If your breast cancer journey involves metastasis, you may be wondering what to expect and if radiation therapy is an option for you. Here are some questions you can ask your doctor to get the conversation started:
- What type of breast cancer do I have? Does it have a risk of spreading?
- Does my breast cancer have a risk of spreading to my brain?
- Will radiation help treat the cancer in my brain? What type of radiotherapy do you recommend?
- How long does radiation treatment typically last? Will I have to take time away from work and daily activities?
- Would I be on any other forms of treatment while receiving radiation?
- How do you expect my cancer to respond to the treatment?
- What financial resources are available to me help cover costs associated with radiation treatment?
- What's the efficacy of radiation treatment?
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