Brain metastases in non-small cell lung cancer (NSCLC) have historically presented significant treatment challenges with limited options. However, the therapeutic landscape has undergone remarkable transformation, offering physicians an expanded arsenal of interventions that can extend survival while preserving quality of life.
Consider the case of Roberta “Robbie” Gimpel, an 81-year-old Boynton Beach resident with a complex oncological history. Following previous diagnoses of bladder cancer and NSCLC, she developed neurological symptoms including gait instability, speech problems, difficulties with daily living and hypersomnia — classic presentations of brain metastases that family members recognized even before the patient was aware of new symptoms.
Yet with sophisticated care at the Eugene M. & Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health, Ms. Gimpel is now doing well. “Despite the cancer moving to her brain, we were able to stop it in its tracks with surgery and radiation therapy,” said Samuel Richter, M.D., radiation oncologist. “She’s strong and a fighter and we want to keep her functional and symptom-free and delay the need for chemotherapy if we can so that she can go out there and live her life.”
Lung cancer’s toll
Nearly 227,000 cases of lung cancer are diagnosed each year in the U.S. It is the leading cause of cancer death, according to the American Lung Association, killing more people in the U.S. than breast, colon and prostate cancers combined.
Up to 20 percent of patients with NSCLC go on to experience brain metastasis. Like Ms. Gimpel, they require a multimodal approach that considers combinations of advanced surgical techniques, precision radiation therapy such as stereotactic radiosurgery (SRS), targeted systemic therapies and sometimes immunotherapy to achieve outcomes that were previously unattainable.
“I’m not foolish enough to believe that I am cured,” Ms. Gimpel said. “But I am hopeful that whatever is next can be helped.” Ms. Gimpel, who began smoking at age 14, has a family history of cancer, although genetic testing did not reveal any known connections.
Optimizing patient outcomes
Since her first cancer diagnosis in 2009, Ms. Gimpel’s care at Lynn Cancer Institute has included internal chemotherapy for bladder cancer, and removal of the left lobe of her lung for lung cancer. She also had hyperfractionated stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiation, to treat lymph node recurrence in her lung, and in 2023 she underwent SBRT again to control pain and the progression of disease in her chest wall.
When the cancer metastasized to her brain, a craniotomy was followed by one session of stereotactic radiosurgery, and later, five SRS treatments to the brain cavity and one to the lesion. “The goal was to avoid the return of the cancer in the operative bed and also to ablate the lesion,” Dr. Richter said.
Living life again
“Within four days of surgery, my cognitive skills returned and after intense therapy, all of my symptoms were gone,” Ms. Gimpel said. Today, she is back to doing what she loves — spending time with her husband, Ron, playing bridge, doing water aerobics and volunteering for Jewish Adoption and Family Care Options, an organization that provides care and support to families in need.
Her case exemplifies how modern oncologic care has transformed brain metastases from a uniformly fatal diagnosis to a manageable condition, allowing patients to maintain hope and continue living meaningful lives despite advanced disease.
“For patients with brain metastases, there are many options, and we work to personalize our care for each scenario,” Dr. Richter said. “It’s important to have a multidisciplinary team at the patient’s side.”
