Patient: 2009-1-10, cough, late sputum with blood, 2009-9-18 CT saw left lung cavity, fibrinoscopy confirmed cancer diagnosis. 2009-9 —- today, four cycles of chemotherapy, the lesion has shrunk, no other organ metastasis, but recently developed neurological and psychiatric symptoms, suspected brain metastasis. (MRI results are pending) Why metastasis during chemotherapy? As brain metastasis is a common phenomenon in lung cancer, how should chemotherapy regimens prevent it? What is the significance of prophylactic irradiation of the brain? Patient: I just want to get the answer to my question, who would like to guide me? Thank you! On the one hand, there is a certain percentage of efficiency of chemotherapy drugs and individual differences in sensitivity, and on the other hand, resistance to chemotherapy drugs is also very common in the course of treatment. From the analysis of your current condition, the primary foci appear to shrink, which proves that the tumor is still sensitive to chemotherapeutic drugs. The reason why brain metastases appear is that there may be micro metastases in the brain before chemotherapy, and the vast majority of chemotherapeutic drugs cannot pass the blood-brain barrier (BBB), so the intracranial metastases cannot be controlled. Prophylactic irradiation of the brain is controversial because the cumulative dose of radiotherapy to the brain is certain. Patient: Dr. Jin Shuai: Hello! Thank you very much for your advice. The patient’s chest CT and brain MRI results came out yesterday: the primary foci were further reduced, and 3cm metastases were found in the brain. At this point, I would like to hear your opinion and advice, if radiotherapy is given, is it local or whole brain? If Chinese medicine is used, is there any medicine that has good effect in penetrating the blood-brain barrier? Will your hospital use the oral lotion of opium bile oil introduced online? Is it really that effective? Thank you! Jin Shuai, Oncology Center of Armed Police General Hospital: Hello, there is a key question you have not explained, what is the type of pathology of the patient? The patient has a single 3cm intracranial metastasis, local radiation therapy is recommended to knock out the metastasis, simple radiation therapy has little effect on the patient, there will be no reaction, which can be assured. I would like to know: 1. pathology; 2. chemotherapy regimen. I have used the oil of opium, it is said to pass through the BBB, (not sure oh) is a common anti-tumor Chinese medicine, beneficial and harmless, economic conditions can be used patient: Dr. Jin : Hello! The type of pathology of the patient refers to the pathology of the primary lung focus? It is adenocarcinoma. Chemotherapy regimen: first two stages: gemcitabine, nedaplatin. The second two stages: paclitaxel, carboplatin. When you say radiotherapy alone that has little effect on the patient, do you mean local irradiation or all radiation therapy? Does local irradiation knock out the lesion, but free cancer cells remain in other parts of the brain and re-form a lesion? What will happen with whole brain irradiation? Thank you! The latest research shows that pemetrexed + platinum is the best regimen for lung adenocarcinoma, and our experience: pemetrexed can be passed by BBB. of course, the regimen of Jianze (gemcitabine) + platinum can’t be said to be wrong, and radiation therapy to the brain alone is safe within the restricted dose, and patients don’t respond much. The damage of radiotherapy to the body is based on the site of radiotherapy. For progressive lung cancer, radiotherapy is the standard treatment at the same time. I don’t know why you don’t have radiotherapy, or the medical condition. Local irradiation to knock out the lesion, other parts can completely reappear, which is what we are worried about in the clinic, too controversial for the prevention of irradiation, the whole brain limit radiation dose is 4000cGy, if the early light is finished. If the whole brain limit radiation dose is 4000 cGy, if the early light is finished, there is really nothing we can do if the lesion appears again. At present, it is not recommended to change the program, but to continue to observe. And why did you change it after 2 cycles? Is it ineffective? The General Hospital of the Armed Forces Oncology Center Jin Shuai: Okay, if you can conveniently join my patient club, or make comments to me, you can always consult patients with questions: Dr. Jin; Hello! It’s been a month since I last asked for advice, during which I was busy with seeing a Chinese medicine doctor and convincing my brain to receive radiotherapy (because the hospital changed the single hair to multiple hair, I have to irradiate the whole brain, 5 times a week, 20 times in total, the charge sheet is 30 wild, I don’t know how much gy is each time?) At present, 11 times (January 20 hospitalization), mental and neurological symptoms have improved, but the whole program is currently only for metastatic metastases, the primary foci even if the body and intermittent factors (the 4th cycle of chemotherapy administration time; 2009-12-), do not consider the same period of radiation, chemotherapy, always Chinese and Western medicine combined anti-cancer treatment, right? Thinking back to the previous treatment, you pointed out: 1. Why did you change the program after two cycles of chemotherapy? (I was told to change the drug in advance, but the reason was not mentioned) 2. The brain metastasis rate of lung (glandular) cancer is extremely high, and the chemotherapy regimen is preferred to drugs that can pass the BBB, but it is useless! (I was told that stage VI, the opportunity of radiotherapy has been lost) I am very worried about the current plan of taking care of the “head” but not the “lung”! I hope Dr. Kim will give me more guidance! Thank you! The General Hospital of the Armed Police Oncology Center Jin Shuai: Hello! The oncologists may have their own considerations in chemotherapy, let’s say: some of them change the chemotherapy regimen (A to B) after 2 cycles of chemotherapy, so when the B regimen is ineffective, the A regimen can be used again, but if the A regimen is ineffective, the B regimen is also ineffective, it will be a problem. Just an example. I don’t know what your doctor thinks. In addition, the chemotherapy drugs that can pass BBB are very limited, and only pemetrexed may pass the mainstream lung cancer regimen, so it is not the doctor’s fault. In progressive lung cancer, it is still recommended to synchronize radiation and chemotherapy, but it can be flexible according to the patient’s actual condition, there is no fixed rigid treatment pattern, I personally suggest to continue chemotherapy. Radiotherapy should be 40Gy if 20 times, and wild is only related to the plan, don’t care.