Episode 013: Heme/Onc Emergencies, Pt. 2: Brain Mets

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 MRIStart patient on steroids Interpreting MRI imaging: T1 post-contrast sequence: to look for brain massT2 sequence: looking for vasogenic edema surrounding brain massMidline shift is an issue more so when it is acute; this is very different than slow changes over timeWho to operate on? Functional status prior to surgery; not in an area that can cause other harm; no other good alternative treatment optionsWhat to tell your NSGY colleague during a consult: A quick neuro exam (consciousness, strength, sensation, focal neurologic issues)Brief cancer historyUnderlying 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, PAJoshua Lowenstein, MD, MBA: Neurosurgery Attending, REX Neurosurgery and Spine Specialists, Raleigh, NC Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast