Brain metastases from systemic cancer are the most common type of intracranial neoplasm in adults, being almost 10 times more common than primary malignant brain tumors, which cause a significant burden on the management of patients with advanced cancer (1). The lungs represent one of the most frequent sources of metastases to the brain, with a probability of (36 64%) (3). Symptoms suffered by the patients include headaches, epilepsy, focal weakness, numbness or changes in mental status. The prognosis of patients with brain metastases is not optimistic and the median survival time is  1 2 months if left untreated. The 1-year survival rate has been recorded as 10.4% (4,5). The treatment of metastatic brain tumors is complex; not only due to being able to provide local control and improve neurological function, but also due to factors such as age, performance and systemic disease status and the size, volume, location and number of metastases at presentation

CyberKnife is a robotic radiosurgery system with a linear particle accelerator (linac), which is coupled with real-time imaging to track and compensate for the patient s or target s motion. As a relatively non-invasive treatment modality, CyberKnife demonstrates certain benefits, including a more accurate target localization and improved dose delivery for the management of metastatic brain tumors that allows higher biologically effective dose delivery without increased incidence of toxicity.

In the present case, the results for the treatment of multiple brain metastases after CyberKnife surgery with a 7 8 Gy marginal dose was promising. CyberKnife for metastatic brain tumors is an effective and safe method for reducing the marginal dose prescribed for multiple brain metastases and for minimizing the radiation-related neurotoxicities. In conclusion, CyberKnife, a focused, highly-targeted radiosurgery and fractionated radiotherapy is particularly useful for multiple brain metastases. CyberKnife provides the advantage of the management of local recurrence and a tolerable complication rate. Although the treatment of brain metastases has been performed with CyberKnife, the clinical significance and optimal dose fractionation scheme require further investigation.

In case you have a concern or query you can always consult an expert & get answers to your questions!

CyberKnife Therapy Of 24 Multiple Brain Metastases From Lung Cancer!

Cancer like most other diseases has the best rates of recovery with early detection and intervention. As there are no regular health screenings for blood cancer, only the awareness about the early warning signs can save your life. November is designated as the Lung Cancer Awareness Month, to ensure every individual is equipped to fight against lung cancer right from the start. Here are 4 vital facts you must know to win your fight against blood cancer.
Lung cancer is also known as pulmonary carcinoma or cancer of the lung. It occurs when DNA mutations develop in the cells/ tissues of the lungs leading up to uncontrolled growth in the tissues of the lung. By far, it is known to be the most common cancer in Asia.

1. Type: lung cancers can present as one of the following types: 

Non-Small Cell Lung Cancer (NSCLC): Most common type of lung cancer and constitutes nearly 85% of all lung cancers. The sub-types of NSCLC are as follows:
Large cell carcinoma
Squamous cell carcinoma (SqCC) (Epidermoid)
Adenocarcinoma   accounts for majority of the NSCLC.
Small Cell Lung Cancer (SCLC): It is also known as oat meal cancer and tends to spread (metastasize) quickly. This constitutes about 15% of the lung cancers.
Mesothelioma: It is a rare cancer that develops in the mesothelial cells of the pleural or peritoneal surfaces. It usually arises in the pleural membrane lining the lungs, known as pleural mesothelioma. One that arises from the peritoneum is called the peritoneal mesothelioma and the one that arises from the pericardium is known as pericardial mesothelioma. Lastly, it can also arise from the tunica vaginalis known as testicular mesothelioma. People working with or prior exposure to asbestos are mostly at risk of developing mesothelioma. The latency period between time of exposure and development of mesothelioma can be somewhere between 20 to 40 years. Maximum of the patients who develop mesothelioma are men.
2. Gender: It affects the male populace predominantly. It is more common in men than in women and in those of lower economic status. However, the incidence of lung cancer, in women too, is on the rise of late.

3. Etiology: Cigarette/ Tobacco smoking remains the most important cause of lung cancer accounting for 85   90% of the cases. Incidence/ risk is proportionate to the number of cigarettes smoked irrespective of the age. Also, environmental toxins including smoke from burning black tar, exhaust gases from automobiles etc. too contribute actively to various lung diseases including cancer. People working in asbestos manufacturing factories who are exposed to asbestos dust are also likely to get lung cancer. Tuberculosis too is an additive risk factor. Again, people who have received ionizing radiation especially to treat Hodgkin Lymphoma or other malignancies also run the risk of developing lung cancer. Above-mentioned causes apart, genetic factors may also play a role.

4. Features: Lung cancer clinically presents in the following ways mainly. Signs & symptoms of malignant mesothelioma are as enumerated below

Difficult/ labored breathing (Dyspnea)
Chest pain
Palpable chest wall mass
Discordant chest wall expansion
Weight loss (Cachexia)
Loss of appetite (Anorexia)
Night sweats
Signs & symptoms of non-small cell lung cancer (NSCLC) are as enumerated below. Majority of patients are symptomatic at diagnosis

Chronic cough
Difficult/ labored breathing (Dyspnea)
Chest pain
Blood stained sputum (Hemoptysis)
Hoarseness
Weight loss (Cachexia)
Loss of appetite (Anorexia)
Weakness
Bone pain
Pleural or pericardial effusion
Superior vena cava syndrome
Brachial plexopathy
Neurologic pain
Hypercalcemia of malignancy
Signs & symptoms of small cell lung cancer (SCLC) are as enumerated below

Symptoms as per the points 8   18 depicted above for NSCLC are applicable for SCLC as well. Additionally, patients suffering from SCLC may have:

Fever associated with chest infections like bronchitis/ pneumonia that refuse to go away or keep coming back
Horner syndrome
Paraneoplastic syndromes including encephalitis/ sub-acute sensory neuropathy, hyponatremia, acromegaly, cancer associated retinopathy, ectopic corticotropic syndrome etc all.
5. Screening: is generally recommended for asymptomatic/ symptomatic populations as surveillance for high-risk individuals   who are either current or former smokers (quit smoking within the last 15 years) have at least a 30 pack-year smoking history and those who do not have any prior history of lung cancer. The goal of screening, as usual, is to be able to detect & diagnose lung cancer at an early stage which is potentially curable. It is mostly radiologic with a low dose helical computed tomography (CT) scan being more effective in detecting early-stage lung cancer than a chest radiograph can.

6. Diagnosis: Abnormal blood test results may be indicative of malignancy, but a follow-up imaging/ biopsy is always the gold standard for an accurate diagnosis. Following are the diagnostics employed mainly:

Blood: Hb may be low, TLC, ESR and polymorphs increased. Adenocarcinomas are likely to express thyroid transcription factor 1 (TTF-1) or carcinoembryonic antigen (CEA). On the other hand, mesotheliomas are likely to express Wilms Tumor -1 (WT-1) protein and Calretinin.
Imaging: Thoracoscopy, Bronchoscopy, X-Ray, CT Scan etc all. Positron Emission Tomography (PET) / CT scan and Magnetic Resonance Imaging (MRI) scan help detect metastasis if any.
Biopsy: It clinches the histologic diagnosis and the nature of the disease.
7. Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.

8. Prognosis: Preventive measures, earlier diagnosis and right early treatment are key for effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for early-stage lung cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient s general health & vitality etc all. The primary determinant of prognosis in NSCLC is the stage at which the cancer is diagnosed. For non-metastatic cancers, however, it is the nodal status that determines the stage and hence the prognosis.

9. Prevention: Rightly said, prevention is always a better choice. Cigarette smoking is to be avoided by all means as it is the single major cause of lung cancer. Even exposure to cigarette smoke (passive or secondhand) is also an established cause of lung cancer and is known to increase the risk of lung cancer in non-smokers as well. Preventing exposure to secondhand smoke can be helpful in decreasing the incidence and mortality of primary lung cancers. Above-mentioned apart, other important risk factors such as exposure to ionizing radiation, environmental carcinogens like smoke from burning black tar, exhaust gases from automobiles, outdoor air pollution, and occupational exposure to asbestos, arsenic, beryllium, nickel, cadmium, chromium etc all too are known to increase the risk for lung cancer and mortality thereof. In fact, cigarette smoking is known to potentiate the effect and hence the lung cancer risk of many of the above-mentioned carcinogens, multi-fold, in smokers. Thus, either eliminating or reducing the exposure to the above-mentioned carcinogens can lead to a decrease in the risk of lung cancer and incidences thereof. Furthermore, randomized clinical trials indicate that high-intensity smokers (only) who take supplementation of beta-carotene have an increased risk/ incidence of lung cancer. Vitamin E supplementation, on the other hand, does not affect the risk of lung cancer as indicated by the trials. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Lung Cancer Awareness Month - Lung Cancer In Nutshell!

As much as you want to avoid, there are things you have no control over. Lung cancer (Bronchogenic Carcinomas) is one such nemesis that can throw life in shambles. The malignant tumor that originates in the lungs slowly spreads onto the other distinct and vital organs as well. Thought to be mostly affecting men who are chain smokers and into severe tobacco consumption, incidences of lung cancer in women are rising at an alarming rate over the past few years. Non-smokers may also be susceptible (to a lesser extent though) to lung cancer.

Lung cancer can be either

Non-small cell lung cancers: The NSCLC, accounting for ~85% of the lung cancer is one of the most common types of lung cancer affecting people, NSCLC may further be divided into
Adenocarcinoma: This type of NSCLC originates mostly in the peripheral regions of the lungs and may affect (spread) the lymph nodes. Non-smokers and women are mostly at the receiving end (other than the chain smokers).
Squamous Cell Carcinoma: Also known as Epidermoid Carcinoma, often affects men, epidermoid carcinoma may originate in the tissues that line the bronchial tubes. The lymph nodes are often affected by Epidermoid Carcinoma.
Large-cell Undifferentiated Carcinoma: The point of origin of large-cell undifferentiated carcinoma is the surface of the lungs. They have a higher probability of spreading to the lymph nodes.
Bronchioalveolar Carcinoma: Though rare, bronchioalveolar carcinoma originates close to the air sacs.
Small Cell Lung Cancer (SCLC, accounting for ~25% of the lung cancer): As the name suggests, SCLC is marked by the rapid proliferation of small cells into large malignant tumors. SCLC can move throughout the body (affecting vital organs).
Radiotherapy to treat Lung cancer:
Radiotherapy plays a pivotal role in the treatment of lung cancer. The radiation therapy is mainly of two types

External beam radiation therapy (EBRT)
Internal radiation therapy (Brachytherapy)
In external beam radiation therapy, high-energy rays are focused on the cancer cells (thereby resulting in the apoptosis of the cancer cells) externally, from outside the body. EBRT is particularly helpful in case of Non-small cell lung cancers.

The EBRT may be of the following types

3D-CRT (Three-dimensional conformal radiation therapy): An advanced radiation therapy, 3D-CRT accurately marks the position of the cancer cells (using advanced computers). The treatment ensures minimum damage to the other healthy cells and tissues (energy rays are directed at the affected cells from different positions).
SBRT (Stereotactic body radiation therapy): This is a radiation therapy used in the treatment of NSCLC, when it is at a nascent stage.
IMRT (Intensity modulated radiation therapy): As the name suggests, in IMRT, the intensity of the radiation reaching the normal tissues and cells can be modulated. Like 3D-CRT, the radiation in IMRT is directed from different angles (for maximum results).
Internal radiation therapy (Brachytherapy): This type of radiation therapy is generally used to deal with lung cancers that tend to block the airways. In this therapy, the radiation process is carried out through a narrow tube, thereby, shrinking and collapsing the tumor.
The effect, dosage, and duration of radiation therapy depend on the stage and severity of the condition. In some cases, radiation therapy may be given together with chemotherapy.

Radiotherapy - Is It Beneficial For Lung Cancer?

Pulmonary diseases are some of the most commonly experienced health conditions all over the world. Millions of people suffer due to various causes including genetics, smoking, pollutants and infection. Now lungs are one of the most important and complex organs of the body. They are the apparatus through which oxygen enters and carbon dioxide gets expelled. 

Lungs expand and contract on a constant basis to ensure that we can breathe properly. Let us find out more about lung or pulmonary diseases.

Asthma: This is one of the most common and potentially fatal conditions that affect children and adults. It grips the airways formed by the bronchi which branch off into smaller tubes from the main trachea that holds them. This condition causes inflammation, and even spasms, which can lead to wheezing and breathlessness. The main triggers of asthma attacks include allergies, infections and pollutants that may escape into the airways.
COPD: This is also known as Chronic Obstructive Pulmonary Disorder. It is an umbrella term used for various lung conditions that cause breathing difficulties due to an obstruction of the airways. Chronic bronchitis is one of the conditions that falls under COPD, and is usually characterised by persistent, hacking coughs.
Cystic Fibrosis: This is another condition that affects the airways by causing poor passage of mucus from the bronchial tubes. This condition is a genetic one where the mucus that gathers eventually becomes a lung infection.
Pneumonia: This is a condition that causes an infection in the alveoli, which are the tiny tubes that the airways branch into. These are air sacs that can catch myriad infections like pneumonia.
Tuberculosis: This is also a kind of pneumonia, which is caused by bacteria called Mycobacterium Tuberculosis. This condition usually attacks the air sacs of the lungs and can be a potentially fatal disease if it is not treated on time. The patient will require immediate hospitalisation.
Pulmonary Edema: This condition is caused by fluid leaks from the tiny blood vessels into the surrounding air sacs within the lungs. It can also be caused due to heart failure as well as back pressure which falls on the lungs. Direct injury to the lungs can also lead to this condition.
Lung Cancer: This is a fatal disease which can be found in any part of the lungs. It has many forms and the type as well as the location usually determines the kind of treatment option that will be followed.
Acute Respiratory Distress Syndrome: When the lungs suffer a sudden injury which is usually caused by a bout of serious illness, it is called ARDS. Treatment involves the use of life support ventilation.

All About Pulmonary Diseases

Lungs are very important organs of your body as they play a pivotal role in respiration. Lung cancer refers to the gradual development of cancerous cells in the lungs. Many common symptoms can help you to identify lung cancer. They are stated below:

A) persistent cough
B) change in your voice
C) pain in the chest region
D) breathing problem
E) fatigue
F) loss of weight and appetite
G) sometimes a person may also cough up blood
H) cough accompanied by a wheezing sound

Lung cancer is very fatal and has less chances of getting cured. However, ayurveda offers effective and natural remedies for treating lung cancer. They are mentioned as follows:

1. Practice breathing exercises regularly: breathing exercises can help you to deal with the problem of lung cancer in an effective manner.

2. Quit smoking and avoid drinking alcohol: this is absolutely essential for treating lung cancer. Both smoking and consuming alcohol can cause severe damage to your lungs.

3. Practice meditation. According to ayurveda, meditation is known to have great healing powers for any health problem. This can help you to cope up with cancer as well.

4. Avoid junk foods and carbonated drinks: consuming these foods frequently can worsen your condition.

5. Massage therapy: sometimes massage therapy can work wonders in ayurveda. Massaging certain essential oils can be very helpful.

6. Aromatherapy: aromatherapy can also prove to be effective in treating lung cancer. It is a procedure in which essential oils are not only used for massaging your body but also for inhaling.

7. Ayurvedic herbs: there are many ayurvedic medicines and herbs also which can treat lung cancer efficiently.

Since lung cancer involves very less survival rate, it is of utmost importance that you go the doctor immediately once you start noticing any of the above mentioned symptoms.

Treating Lung Cancer With Ayurveda

Without our lungs, it would be impossible to breathe. People suffering from chronic lung diseases have compromised lung functioning. This leads to shortness of breath, fatigue and weakness. In turn, this can make the person avoid anything that exerts the lungs such as exercise. While this may seem like a good idea, it is actually detrimental. Not exercising can further weaken the lungs and muscles and make this a vicious cycle. This is where physiotherapy can help with lung rehabilitation or pulmonary rehabilitation.

Physiotherapy is a branch of medicine that treats diseases and health conditions with exercise and manual therapy. Physiotherapists may also use radiation, sound waves, electric therapy, prosthesis and assistive devices. The aim here is not to cure the disease but to improve lung functioning and the patient s quality of life. Pulmonary rehabilitation can help in a number of ways.

It reduces breathlessness: As the lung muscles weaken, their ability to pump oxygen and transport it to the other parts of the body reduces. This can make a person feel breathless even with the slightest exertion. Lung rehabilitation works on strengthening the lung muscles to reduce this breathlessness.
It increases muscle strength in the arms and legs: When oxygen does not reach the limbs, they, in turn, get weaker. By strengthening the lungs, lung rehabilitation increases the muscle strength in the patient s arms and legs.
It increases stamina and endurance: Stamina is directly linked to lung functioning. By helping the patient breathe more comfortably, lung rehabilitation increases the patient s stamina and helps him or her endure more physical exercise.
It helps patients understand your condition: Physiotherapy is part exercise and part education. By helping patients get an insight into their condition, physiotherapy helps them come to terms with their limitations and motivates them to work harder towards overcoming them.
It increases self-confidence: Feeling breathless and tired all the time can make people feel frustrated. This is especially so because these things cannot be controlled without help. Physiotherapy teaches patients how to deal with these issues and thus increases their confidence in dealing with their medical issues.
It makes patients more independent: A lack of energy can make people dependent on others. Even simple tasks like getting a bottle of water from the fridge can seem like a tiring task. Physiotherapy improves lung functioning and hence makes the person feel less tired doing everyday tasks. This makes the person more independent and improves their quality of life.

Lung Rehabilitation With Physiotherapy!

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