When Lung Cancer Spreads to the Brain, Advanced Care Brings New Hope

For Boynton Beach resident Roberta “Robbie” Gimpel, being diagnosed with cancer multiple times since her move to Florida in 2009 was never part of her life plan. First it was bladder cancer, then non-small cell lung cancer (NSCLC), which spread to her ribs. Each diagnosis brought the same response — a fierce determination to fight back.

But last summer, Ms. Gimpel became unsteady while walking. Her speech was garbled, she had difficulty dressing herself and she wanted to sleep all the time. Family and friends noticed the change, but she seemed unaware. The cancer had spread to her brain, something that happens in up to 20 percent of patients with NSCLC, according to the American Lung Association.

Fortunately, after sophisticated care at the Eugene M. & Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health, Ms. Gimpel shows no signs of cancer today.

“I’m not foolish enough to believe that I am cured, but hopeful that whatever is next can be helped,” the 81-year-old says.

“Despite the cancer moving to her brain, we were able to stop it in its tracks with surgery and radiation therapy,” says Samuel Richter, M.D., a radiation oncologist with Lynn Cancer Institute. “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.”

About Lung Cancer

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 and is the second-most common cancer (after skin cancer) in both men and women.

While anyone can get lung cancer, Ms. Gimpel was at increased risk. She had a family history of cancer, with her mother having pancreatic and liver cancer and her father having prostate and lung cancer.

While anyone can get lung cancer, Ms. Gimpel was at increased risk. She had a family history of cancer, with her mother having pancreatic and liver cancer and her father having prostate and lung cancer.

Although genetic testing did not show any signs of inherited cancer, Ms. Gimpel had begun smoking at age 14. Tobacco use is a major risk factor for multiple cancers, including bladder and lung.

Symptoms of Lung Cancer

Ms. Gimpel’s bladder cancer gave her no warning signs but was caught at an annual gynecological appointment. Later, when she suffered from chest pain, a CT scan found the lesion in her lung.

In addition to chest pain, symptoms of lung cancer include:

• A cough that lingers or worsens and may include coughing up blood
• Hoarseness
• Shortness of breath
• Loss of appetite and unexplained weight loss
• Fatigue
• Repeated lung infections

Over the years, Ms. Gimpel’s care at Lynn Cancer Institute has included internal chemotherapy for bladder cancer, and, for lung cancer, the removal of the left lobe of her lung.

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, Ms. Gimpel had a craniotomy to remove the large mass and alleviate pressure in her brain, and then five sessions of fractionated stereotactic radiosurgery (SRS), which delivered a very high dose of precisely targeted radiation to the area.

At the same time, she also had an intact lesion that was not removed at surgery. Doctors delivered a single fraction of SRS to the lesion. “The goal was to avoid the return of the cancer in the operative bed,” Dr. Richter says, “and also ablate the lesion.”

Living Life Again

“Within four days of surgery, my cognitive skills returned, and after intense therapy, all of my symptoms were gone,” Ms. Gimpel says. 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 children and families in need.

“I am so very fortunate,” Ms. Gimpel said. “The best thing that happened to me was finding the doctors at Lynn Cancer Institute.”

Her treatment reflects both the advances in cancer care in the last decade and the importance of having a multidisciplinary team at her side, Dr. Richter says. “For patients with brain metastases, there are many options, and we work to personalize our care for each scenario.”

Dr. Richter and other physicians at the Institute are also leading clinical trials on a variety of treatments for cancer that has spread to the brain. One trial that is currently accruing patients is testing if additional radiation treatments can help delay the time until cancer returns or worsens.

The study is comparing patients who receive three stereotactic radiosurgery treatments in one week versus the standard one-day radiation treatment. The lead principal investigator nationally is Rupesh Kotecha, M.D., chief of radiosurgery and director of the Central Nervous System Metastasis program at Baptist Health Miami Cancer Institute. Dr. Richter is the institutional principal investigator for Lynn Cancer Institute.