Question: My 70 yr old single sister was diagnosed with small cell lung cancer in 6/15, with mets to the brain, bone and liver. She immediately got 7 brain cyberknife treatments and chemo, carboplatin and etoposide. She tolerated all well. After six months, multiple brain mets (8) appeared. She received whole brain radiation (10 tx), completed in 12/15. About a month later, pain in clavicle showed mets to the bone and received local radiation which relieved pain. CT scan in 5/16 showed growth in the lung, adrenals and liver. Chemo started still continuing. Now, 6/16, most recent MRI shows recurrence of brain mets (10), some small and some 2.5 cm, and swelling.
Radiation oncologist says she does not recommend any further radiation and has gently advised us she believes her expectancy is 3-4 months . Recommends decadron 4 mg every six hours and Namenda. Oncologist seemed torn but is continuing chemo in the event that it helps with symptoms and pain in her other systems. . So far, my sister has fatigue, but no pain. The MRI Results were shared with me, as usual with all her tests, per my sister's instructions. We are very close and she has been living with me since her Dx. I take her to every medical apt, tx etc . Withholding information from her is very out of character for me and she would not expect that I would. I did not lie and neither did the DR. We both said" The MRI showed swelling in the brain and decadron is recommended to reduce swelling". A sin of omission.

Her mood is excellent and she has remained positive and hopeful throughout the whole ordeal. So far, my siblings and I have chosen not to tell her the bad news and prognosis. We have asked the oncologist not to tell her and she ha agreed, compassionately believing it will ruin the good quality of life for the little time she has left. She put all her affairs completely in order when she was first diagnosed and nothing remains to be done.

Summer is her season and she is looking forward to a wonderful summer, full of friends and family visiting. We can see no benefit in giving her the bad news which will undoubtedly devastate her and she will crash emotionally. We are a well educated, intelligent, sensitive and supportive family that wants to do the right thing.

My questions:
Should we seek another opinion as to whether the WBR should be tried again. We know it is not often done but it is done. I did not push or challenge the radiation oncologist when she told me ( I was stunned) and now wonder whether I should have, On the other hand, I don't want to call and give her the impresson we are pushing for more TX if it will just torture her. She is happy now. I am hoping hearing her story you can tell us if her not recommending any more radiation so soon after the WBR is undoubtedly the right course of action so we can have peace of mind and continue focusing on providing her with the highest qualityy of life for as long as possible. If we thought there was any question at all, and that there was actually a decision to be made, we would feel obligated to give our sister the choice herself.

Decadron has been prescribed 4 mg every six hours. Does this mean three or four doses in a 24 hour period? One doctor advises to try to squeeze four doses in a 24 hour period but not to give any after 8 PM , which would mean every four hours. Another doctor says three doses in a 24 hour period is sufficient and not to disturb her sleep as the medication needs to be administered with food. We know this is an important medication to reduce swelling in the brain and would like to have her get maximum benefit. Do you think it's OK to squeeze in four doses, which would really mean every four hours not every six hours – is this safe and OK?