Brain Mets & Progression

Hey Maria,

So sorry for all of it.  Perhaps Kyle Z will respond….he has dealt with many brain met recurrences…some requiring surgery and is still ticking right along!!  So there is hope….though I don't blame you for feeling the path has been more than sucky!!!  Are you BRAF+ by any chance…because BRAF inhibitors have been proven to be effective in brain mets as well….????  However, there are other systemic treatments you might ask about.  For instance, Kyle is doing nivo with lirilumab and I believe it has been working well for him.

Fingers crossed for you and yours.  Celeste

Hey Maria,

So sorry for all of it.  Perhaps Kyle Z will respond….he has dealt with many brain met recurrences…some requiring surgery and is still ticking right along!!  So there is hope….though I don't blame you for feeling the path has been more than sucky!!!  Are you BRAF+ by any chance…because BRAF inhibitors have been proven to be effective in brain mets as well….????  However, there are other systemic treatments you might ask about.  For instance, Kyle is doing nivo with lirilumab and I believe it has been working well for him.

Fingers crossed for you and yours.  Celeste

Maria,

I'll keep thinking and looking. I am so glad that you are seeking a second opinion. I just don't see the point of WBR. The damage might (might!!!!!!!!!!) somehow be worth it IF the data showed outcomes were better. Sadly, that is not what the data shows us. Hang in there. Seek care and all your options! C

Maria,

I'll keep thinking and looking. I am so glad that you are seeking a second opinion. I just don't see the point of WBR. The damage might (might!!!!!!!!!!) somehow be worth it IF the data showed outcomes were better. Sadly, that is not what the data shows us. Hang in there. Seek care and all your options! C

Maria,

I'll keep thinking and looking. I am so glad that you are seeking a second opinion. I just don't see the point of WBR. The damage might (might!!!!!!!!!!) somehow be worth it IF the data showed outcomes were better. Sadly, that is not what the data shows us. Hang in there. Seek care and all your options! C

Hey Maria,

So sorry for all of it.  Perhaps Kyle Z will respond….he has dealt with many brain met recurrences…some requiring surgery and is still ticking right along!!  So there is hope….though I don't blame you for feeling the path has been more than sucky!!!  Are you BRAF+ by any chance…because BRAF inhibitors have been proven to be effective in brain mets as well….????  However, there are other systemic treatments you might ask about.  For instance, Kyle is doing nivo with lirilumab and I believe it has been working well for him.

Fingers crossed for you and yours.  Celeste

Hi Maria,

I was also very scared at the possibility of whole brain radiation/WBR. I am really glad that for my second brain surgery in 2011 I was able to be treated at UCSF. They did Gamma Knife afterwards, and there was no talk of WBR. That's the main thing I would strongly question if WBR was recommended to me at any point, especially depending on what doctors/facility I was being treated at.

Given that, if there's time before your upcoming craniotomy surgery, or right after, for myself I would seek a second opinion at a major cancer center on whether the radiation follow-up to surgery can be Gamma Knife or Cyber Knife (or etc) as opposed to WBR. I don't know where you're being treated. But major centers like Yale and UCSF will prefer to treat with Gamma Knife even if it's a dozen or twenty or more brain mets with Gamma Knife rather than WBR, depending on the circumstances. A big place like that is also good at fighting down insurance companies who may try to approve only cheaper WBR. A UCSF or Yale has the credibility to tell the insurance company when Gamma Knife (etc) is appropriate and has good results, even with more than 3 tumors, which is the obsolete insurance cut-off point for only recommending WBR. 

Anyway, like you, in 2011 one of my brain mets failed the CyberKnife treatment I got in 2010, and grew back to about 3.5 cm before surgery. It also spread to a few other places in my brain too. At that point UCSF did a double craniotomy, physically taking out two. Then very quickly after (two weeks only) they followed up with Gamma Knife to the two resected tumor beds. And also they radiated two much smaller spots that they didn't do surgery on.

One thing I'll say about actual brain surgery, is that it was nice to feel that they actually physically got that stuff out of my head. Opened it up, scraped it out, good and gone, knock on wood. 

Obviously I'm not a doctor so I don't know what reasons your doctors may be recommending WBR over follow-up with Gamma Knife. Even if it's a prestigious cancer center I would likely still ask for a second opinion if they were telling me WBR.

Good luck on your surgery and the radiation follow-up, whichever way it needs to go. 
And on getting a second opinion if you choose to do that.

Maria, the reason I mentioned Yale was because of this webinar on the Melanoma International web site, which was with Dr. Veronica Chiang, director of Yale's Gamma Knife program. Did she do your first Gamma Knife? In any case, since you're being treated at Yale this it should be worth viewing, even though you must be super busy getting ready for the appointments Monday. It may help in terms of asking questions when you interview the different doctors. See here, "Radiation Treatment of Melanoma Brain Metastases":

http://melanomainternational.org/webinar/2012/01/radiation-treatment-in-brain-metastases/

If the link doesn't work let us know — but it should. It's from 2012 but believe it's as current today as it was then. She talks quite a bit about WBR vs. Gamma Knife.

I lucked into UCSF being a very highly rated Neurosurgery progoram. I know UCSF was called in to consult on Ted Kennedy's brain tumor. According to one ranking (US News & World Report) their Neurosurgery program is ranked #4 in the US. They did a double craniotomy — left parietal tumor and right temporal tumor — each a little over 3cm. I recall reading I was on the table for a good 10 hours, although I don't know where I put the surgery summary notes. 

For what it's worth, here's that Neurosurgery program ranking. Several facilities near you are rated in the top ten, including NY Presbyterian and NYU. I believe NYU has a strong melanoma program as well. For whatever reason, strangely enough MSK is not so high up on this particular Neurosurgery program list:

http://health.usnews.com/best-hospitals/rankings/neurology-and-neurosurgery

I did feel the difference between how I felt after UCSF and Kaiser surgeries. I will say that I have not had a recurrence in the tumor location Kaiser resected. And I'm surprised they could and did the double surgery, too. It's possible it's something some doctors and/or facilities might not be equipped to do. I think usually in general, any place will want a tumor to be over a certain size to do a craniotomy on it.

To be clear the place that did the double craniotomy was UCSF. Kaiser did a single one, on the left occipital area.

To be clear the place that did the double craniotomy was UCSF. Kaiser did a single one, on the left occipital area.

To be clear the place that did the double craniotomy was UCSF. Kaiser did a single one, on the left occipital area.

Maria, maybe the doctor will explain it to you differently when you see her. Which is on Monday? These are good questions to be armed with when you go in.

I can say there are some folks who have posted here, who had WBR and recovered. For them it was not just palliative. One size doesn't fit all, ie., the webinar. I hope she will explain to you in full detail what she feels your situation is, and what the reasoning is behind each part of the plan that is being put together. 

Maybe they want to use WBR as a kind of 'sensitizer' to boost the immunotherapy treatment that they are planning to resume. If that's the case, it would obviously be good to know. I would want to know the rationale for what is being done, including what they think they can do, what they think they can't, and why. 

More questions for her and any second opinion doc might be, do they view WBR as palliative only? 

How many tumors are not candidates for resection? 

What is the reason to do WBR rather than a second round of Gamma Knife/GK? Is it total volume? Or some other reason? If it is total volume, does that volume just include tumors that can't be resected? Or does it include some that in theory might be? 

If by magic, all the resectable tumors could be removed, would that reduce the volume of everything else to the point that GK could be used for the rest rather than WBR? 

I wonder if, back in 2011, I was being seen at Yale or MSK, whether they would they have been able to do the double craniotomy on me that UCSF did. Whether my case has any similarity to yours is hard to know since tumors/locations are bt nature different in any two patients.

If what UCSF did for me was something special, above and beyond the "average" place, I wonder if getting a second neurosurgery opinion at another facility that is also tops on that neurosurgery rating list, i.e., NYU or NY Presbyterian, would be useful or give any different answer than you are getting right now.

These are just questions to try to get the full story. And possibly see if there are different neurosurgery options. I don't want to "get your hopes up", but as you say you have a ton of fight left in you, and second opinions are sometimes valuable. And also, maybe the reasoning is different than that video would suggest.

I hope you get answers, and a plan you can have some hope and confidence in.

Maria, maybe the doctor will explain it to you differently when you see her. Which is on Monday? These are good questions to be armed with when you go in.

I can say there are some folks who have posted here, who had WBR and recovered. For them it was not just palliative. One size doesn't fit all, ie., the webinar. I hope she will explain to you in full detail what she feels your situation is, and what the reasoning is behind each part of the plan that is being put together. 

Maybe they want to use WBR as a kind of 'sensitizer' to boost the immunotherapy treatment that they are planning to resume. If that's the case, it would obviously be good to know. I would want to know the rationale for what is being done, including what they think they can do, what they think they can't, and why. 

More questions for her and any second opinion doc might be, do they view WBR as palliative only? 

How many tumors are not candidates for resection? 

What is the reason to do WBR rather than a second round of Gamma Knife/GK? Is it total volume? Or some other reason? If it is total volume, does that volume just include tumors that can't be resected? Or does it include some that in theory might be? 

If by magic, all the resectable tumors could be removed, would that reduce the volume of everything else to the point that GK could be used for the rest rather than WBR? 

I wonder if, back in 2011, I was being seen at Yale or MSK, whether they would they have been able to do the double craniotomy on me that UCSF did. Whether my case has any similarity to yours is hard to know since tumors/locations are bt nature different in any two patients.

If what UCSF did for me was something special, above and beyond the "average" place, I wonder if getting a second neurosurgery opinion at another facility that is also tops on that neurosurgery rating list, i.e., NYU or NY Presbyterian, would be useful or give any different answer than you are getting right now.

These are just questions to try to get the full story. And possibly see if there are different neurosurgery options. I don't want to "get your hopes up", but as you say you have a ton of fight left in you, and second opinions are sometimes valuable. And also, maybe the reasoning is different than that video would suggest.

I hope you get answers, and a plan you can have some hope and confidence in.

Maria, maybe the doctor will explain it to you differently when you see her. Which is on Monday? These are good questions to be armed with when you go in.

I can say there are some folks who have posted here, who had WBR and recovered. For them it was not just palliative. One size doesn't fit all, ie., the webinar. I hope she will explain to you in full detail what she feels your situation is, and what the reasoning is behind each part of the plan that is being put together. 

Maybe they want to use WBR as a kind of 'sensitizer' to boost the immunotherapy treatment that they are planning to resume. If that's the case, it would obviously be good to know. I would want to know the rationale for what is being done, including what they think they can do, what they think they can't, and why. 

More questions for her and any second opinion doc might be, do they view WBR as palliative only? 

How many tumors are not candidates for resection? 

What is the reason to do WBR rather than a second round of Gamma Knife/GK? Is it total volume? Or some other reason? If it is total volume, does that volume just include tumors that can't be resected? Or does it include some that in theory might be? 

If by magic, all the resectable tumors could be removed, would that reduce the volume of everything else to the point that GK could be used for the rest rather than WBR? 

I wonder if, back in 2011, I was being seen at Yale or MSK, whether they would they have been able to do the double craniotomy on me that UCSF did. Whether my case has any similarity to yours is hard to know since tumors/locations are bt nature different in any two patients.

If what UCSF did for me was something special, above and beyond the "average" place, I wonder if getting a second neurosurgery opinion at another facility that is also tops on that neurosurgery rating list, i.e., NYU or NY Presbyterian, would be useful or give any different answer than you are getting right now.

These are just questions to try to get the full story. And possibly see if there are different neurosurgery options. I don't want to "get your hopes up", but as you say you have a ton of fight left in you, and second opinions are sometimes valuable. And also, maybe the reasoning is different than that video would suggest.

I hope you get answers, and a plan you can have some hope and confidence in.

Maria, the reason I mentioned Yale was because of this webinar on the Melanoma International web site, which was with Dr. Veronica Chiang, director of Yale's Gamma Knife program. Did she do your first Gamma Knife? In any case, since you're being treated at Yale this it should be worth viewing, even though you must be super busy getting ready for the appointments Monday. It may help in terms of asking questions when you interview the different doctors. See here, "Radiation Treatment of Melanoma Brain Metastases":

http://melanomainternational.org/webinar/2012/01/radiation-treatment-in-brain-metastases/

If the link doesn't work let us know — but it should. It's from 2012 but believe it's as current today as it was then. She talks quite a bit about WBR vs. Gamma Knife.

I lucked into UCSF being a very highly rated Neurosurgery progoram. I know UCSF was called in to consult on Ted Kennedy's brain tumor. According to one ranking (US News & World Report) their Neurosurgery program is ranked #4 in the US. They did a double craniotomy — left parietal tumor and right temporal tumor — each a little over 3cm. I recall reading I was on the table for a good 10 hours, although I don't know where I put the surgery summary notes. 

For what it's worth, here's that Neurosurgery program ranking. Several facilities near you are rated in the top ten, including NY Presbyterian and NYU. I believe NYU has a strong melanoma program as well. For whatever reason, strangely enough MSK is not so high up on this particular Neurosurgery program list:

http://health.usnews.com/best-hospitals/rankings/neurology-and-neurosurgery

I did feel the difference between how I felt after UCSF and Kaiser surgeries. I will say that I have not had a recurrence in the tumor location Kaiser resected. And I'm surprised they could and did the double surgery, too. It's possible it's something some doctors and/or facilities might not be equipped to do. I think usually in general, any place will want a tumor to be over a certain size to do a craniotomy on it.

Maria, the reason I mentioned Yale was because of this webinar on the Melanoma International web site, which was with Dr. Veronica Chiang, director of Yale's Gamma Knife program. Did she do your first Gamma Knife? In any case, since you're being treated at Yale this it should be worth viewing, even though you must be super busy getting ready for the appointments Monday. It may help in terms of asking questions when you interview the different doctors. See here, "Radiation Treatment of Melanoma Brain Metastases":

http://melanomainternational.org/webinar/2012/01/radiation-treatment-in-brain-metastases/

If the link doesn't work let us know — but it should. It's from 2012 but believe it's as current today as it was then. She talks quite a bit about WBR vs. Gamma Knife.

I lucked into UCSF being a very highly rated Neurosurgery progoram. I know UCSF was called in to consult on Ted Kennedy's brain tumor. According to one ranking (US News & World Report) their Neurosurgery program is ranked #4 in the US. They did a double craniotomy — left parietal tumor and right temporal tumor — each a little over 3cm. I recall reading I was on the table for a good 10 hours, although I don't know where I put the surgery summary notes. 

For what it's worth, here's that Neurosurgery program ranking. Several facilities near you are rated in the top ten, including NY Presbyterian and NYU. I believe NYU has a strong melanoma program as well. For whatever reason, strangely enough MSK is not so high up on this particular Neurosurgery program list:

http://health.usnews.com/best-hospitals/rankings/neurology-and-neurosurgery

I did feel the difference between how I felt after UCSF and Kaiser surgeries. I will say that I have not had a recurrence in the tumor location Kaiser resected. And I'm surprised they could and did the double surgery, too. It's possible it's something some doctors and/or facilities might not be equipped to do. I think usually in general, any place will want a tumor to be over a certain size to do a craniotomy on it.

Hi Maria,

I was also very scared at the possibility of whole brain radiation/WBR. I am really glad that for my second brain surgery in 2011 I was able to be treated at UCSF. They did Gamma Knife afterwards, and there was no talk of WBR. That's the main thing I would strongly question if WBR was recommended to me at any point, especially depending on what doctors/facility I was being treated at.

Given that, if there's time before your upcoming craniotomy surgery, or right after, for myself I would seek a second opinion at a major cancer center on whether the radiation follow-up to surgery can be Gamma Knife or Cyber Knife (or etc) as opposed to WBR. I don't know where you're being treated. But major centers like Yale and UCSF will prefer to treat with Gamma Knife even if it's a dozen or twenty or more brain mets with Gamma Knife rather than WBR, depending on the circumstances. A big place like that is also good at fighting down insurance companies who may try to approve only cheaper WBR. A UCSF or Yale has the credibility to tell the insurance company when Gamma Knife (etc) is appropriate and has good results, even with more than 3 tumors, which is the obsolete insurance cut-off point for only recommending WBR. 

Anyway, like you, in 2011 one of my brain mets failed the CyberKnife treatment I got in 2010, and grew back to about 3.5 cm before surgery. It also spread to a few other places in my brain too. At that point UCSF did a double craniotomy, physically taking out two. Then very quickly after (two weeks only) they followed up with Gamma Knife to the two resected tumor beds. And also they radiated two much smaller spots that they didn't do surgery on.

One thing I'll say about actual brain surgery, is that it was nice to feel that they actually physically got that stuff out of my head. Opened it up, scraped it out, good and gone, knock on wood. 

Obviously I'm not a doctor so I don't know what reasons your doctors may be recommending WBR over follow-up with Gamma Knife. Even if it's a prestigious cancer center I would likely still ask for a second opinion if they were telling me WBR.

Good luck on your surgery and the radiation follow-up, whichever way it needs to go. 
And on getting a second opinion if you choose to do that.

Hi Maria,

I was also very scared at the possibility of whole brain radiation/WBR. I am really glad that for my second brain surgery in 2011 I was able to be treated at UCSF. They did Gamma Knife afterwards, and there was no talk of WBR. That's the main thing I would strongly question if WBR was recommended to me at any point, especially depending on what doctors/facility I was being treated at.

Given that, if there's time before your upcoming craniotomy surgery, or right after, for myself I would seek a second opinion at a major cancer center on whether the radiation follow-up to surgery can be Gamma Knife or Cyber Knife (or etc) as opposed to WBR. I don't know where you're being treated. But major centers like Yale and UCSF will prefer to treat with Gamma Knife even if it's a dozen or twenty or more brain mets with Gamma Knife rather than WBR, depending on the circumstances. A big place like that is also good at fighting down insurance companies who may try to approve only cheaper WBR. A UCSF or Yale has the credibility to tell the insurance company when Gamma Knife (etc) is appropriate and has good results, even with more than 3 tumors, which is the obsolete insurance cut-off point for only recommending WBR. 

Anyway, like you, in 2011 one of my brain mets failed the CyberKnife treatment I got in 2010, and grew back to about 3.5 cm before surgery. It also spread to a few other places in my brain too. At that point UCSF did a double craniotomy, physically taking out two. Then very quickly after (two weeks only) they followed up with Gamma Knife to the two resected tumor beds. And also they radiated two much smaller spots that they didn't do surgery on.

One thing I'll say about actual brain surgery, is that it was nice to feel that they actually physically got that stuff out of my head. Opened it up, scraped it out, good and gone, knock on wood. 

Obviously I'm not a doctor so I don't know what reasons your doctors may be recommending WBR over follow-up with Gamma Knife. Even if it's a prestigious cancer center I would likely still ask for a second opinion if they were telling me WBR.

Good luck on your surgery and the radiation follow-up, whichever way it needs to go. 
And on getting a second opinion if you choose to do that.

Also, regarding treatment timing intervals in 2011 at UCSF, they were able to go from brain surgery to IPI in 4 weeks:

Craniotomy: June 1st

Gamma Knife follow-up: June 17th

IPI treatment start: June 28th

Maria,

No pain anywhere after UCSF in 2011. Memory has faded a bit more for Kaiser craniotomy in 2010. In both cases they gave me some mild painkillers that I ate a few the few days after surgery. But I don't remember pain being an issue. 

Maria,

No pain anywhere after UCSF in 2011. Memory has faded a bit more for Kaiser craniotomy in 2010. In both cases they gave me some mild painkillers that I ate a few the few days after surgery. But I don't remember pain being an issue. 

Maria,

No pain anywhere after UCSF in 2011. Memory has faded a bit more for Kaiser craniotomy in 2010. In both cases they gave me some mild painkillers that I ate a few the few days after surgery. But I don't remember pain being an issue. 

Also, regarding treatment timing intervals in 2011 at UCSF, they were able to go from brain surgery to IPI in 4 weeks:

Craniotomy: June 1st

Gamma Knife follow-up: June 17th

IPI treatment start: June 28th

Also, regarding treatment timing intervals in 2011 at UCSF, they were able to go from brain surgery to IPI in 4 weeks:

Craniotomy: June 1st

Gamma Knife follow-up: June 17th

IPI treatment start: June 28th

Hi Maria,

Like some of the others, I highly recommend getting a second opinion. Going to WBR is a OLD "first line of treatment" and has been shown not to offer the best results. Gamma Knife Radiation (SRS) is the way to go.

However, you must find a excellent team. My Mom's first experience with SRS was not good. The radiation oncologist said a brain met was a blood vessel the day of the treatment and then on followup… It wasn't and she ended up with 17 more 4 months later. We have learned the hard way that you need to get second or even third opinions even after treatment with your current team, as they may not really be the best…  Finding the best, even if it means travel or switching doctors has been the best choices we have made. And we've done that a few times and now have a excellent team of professionals that I can't recommend enough 🙂

My Mom had a craniotomy and was suppose to start Keytruda a month out last year. She ended up with a new brain met when she had the followup MRI. It was treated with Gamma Knife Radiation and started Keytruda 2 weeks later.  – Great results with this treatment!

Her radiation oncologist is Dr. Eric Chang at USC in Los Angeles. Besides his great personality, he's brilliant and caring. I also know that when he and his team are planning the treatment, after mapping the brain mets, he has a lot of "eyes" on the MRI's because he is at a teaching hospital and working with some of the best people in the field.  If you can find someone like him I'd recommend you go.

Good Luck!

Hi Maria,

Like some of the others, I highly recommend getting a second opinion. Going to WBR is a OLD "first line of treatment" and has been shown not to offer the best results. Gamma Knife Radiation (SRS) is the way to go.

However, you must find a excellent team. My Mom's first experience with SRS was not good. The radiation oncologist said a brain met was a blood vessel the day of the treatment and then on followup… It wasn't and she ended up with 17 more 4 months later. We have learned the hard way that you need to get second or even third opinions even after treatment with your current team, as they may not really be the best…  Finding the best, even if it means travel or switching doctors has been the best choices we have made. And we've done that a few times and now have a excellent team of professionals that I can't recommend enough 🙂

My Mom had a craniotomy and was suppose to start Keytruda a month out last year. She ended up with a new brain met when she had the followup MRI. It was treated with Gamma Knife Radiation and started Keytruda 2 weeks later.  – Great results with this treatment!

Her radiation oncologist is Dr. Eric Chang at USC in Los Angeles. Besides his great personality, he's brilliant and caring. I also know that when he and his team are planning the treatment, after mapping the brain mets, he has a lot of "eyes" on the MRI's because he is at a teaching hospital and working with some of the best people in the field.  If you can find someone like him I'd recommend you go.

Good Luck!

Hi Maria,

Like some of the others, I highly recommend getting a second opinion. Going to WBR is a OLD "first line of treatment" and has been shown not to offer the best results. Gamma Knife Radiation (SRS) is the way to go.

However, you must find a excellent team. My Mom's first experience with SRS was not good. The radiation oncologist said a brain met was a blood vessel the day of the treatment and then on followup… It wasn't and she ended up with 17 more 4 months later. We have learned the hard way that you need to get second or even third opinions even after treatment with your current team, as they may not really be the best…  Finding the best, even if it means travel or switching doctors has been the best choices we have made. And we've done that a few times and now have a excellent team of professionals that I can't recommend enough 🙂

My Mom had a craniotomy and was suppose to start Keytruda a month out last year. She ended up with a new brain met when she had the followup MRI. It was treated with Gamma Knife Radiation and started Keytruda 2 weeks later.  – Great results with this treatment!

Her radiation oncologist is Dr. Eric Chang at USC in Los Angeles. Besides his great personality, he's brilliant and caring. I also know that when he and his team are planning the treatment, after mapping the brain mets, he has a lot of "eyes" on the MRI's because he is at a teaching hospital and working with some of the best people in the field.  If you can find someone like him I'd recommend you go.

Good Luck!

I'm thinking it must matter who one gets a second opinion from, too. In this situation would you go to an oncologist, a neurosurgeon or a radiation oncologist? If you go to an oncologist will they convene a "tumor board" for a second opinion? At both Kaiser and UCSF I know they convened a multidisciplinary tumor board (radiation oncogists, neurosurgeon, oncologist) to review my case each time and decide on the treatment path for the brain tumors. I don't know if that happens in a second opinion. I wonder who you would go to? The only second opinion l got was in 2010, I went to UCSF to get a second opinion on Kaiser who was treating me for the brain tumors. In 2011, I was being treated at UCSF and did not go for a second opiniom. 

Anyway, I wonder if it's best to go directly to a neurosurgeon. Or is that even possible? Would one get routed to an oncologist for the second opinion? I haven't tried that. I do know a second opinion is going to be from Dr. X, not from "UCSF", "MSK", etc. as a whole. Or could you go to the radiation oncology department? What do you think?

I'm thinking it must matter who one gets a second opinion from, too. In this situation would you go to an oncologist, a neurosurgeon or a radiation oncologist? If you go to an oncologist will they convene a "tumor board" for a second opinion? At both Kaiser and UCSF I know they convened a multidisciplinary tumor board (radiation oncogists, neurosurgeon, oncologist) to review my case each time and decide on the treatment path for the brain tumors. I don't know if that happens in a second opinion. I wonder who you would go to? The only second opinion l got was in 2010, I went to UCSF to get a second opinion on Kaiser who was treating me for the brain tumors. In 2011, I was being treated at UCSF and did not go for a second opiniom. 

Anyway, I wonder if it's best to go directly to a neurosurgeon. Or is that even possible? Would one get routed to an oncologist for the second opinion? I haven't tried that. I do know a second opinion is going to be from Dr. X, not from "UCSF", "MSK", etc. as a whole. Or could you go to the radiation oncology department? What do you think?

I'm thinking it must matter who one gets a second opinion from, too. In this situation would you go to an oncologist, a neurosurgeon or a radiation oncologist? If you go to an oncologist will they convene a "tumor board" for a second opinion? At both Kaiser and UCSF I know they convened a multidisciplinary tumor board (radiation oncogists, neurosurgeon, oncologist) to review my case each time and decide on the treatment path for the brain tumors. I don't know if that happens in a second opinion. I wonder who you would go to? The only second opinion l got was in 2010, I went to UCSF to get a second opinion on Kaiser who was treating me for the brain tumors. In 2011, I was being treated at UCSF and did not go for a second opiniom. 

Anyway, I wonder if it's best to go directly to a neurosurgeon. Or is that even possible? Would one get routed to an oncologist for the second opinion? I haven't tried that. I do know a second opinion is going to be from Dr. X, not from "UCSF", "MSK", etc. as a whole. Or could you go to the radiation oncology department? What do you think?