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2015 ; 33
(30
): 3475-84
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Treatment of Brain Metastases
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Lin X
; DeAngelis LM
J Clin Oncol
2015[Oct]; 33
(30
): 3475-84
PMID26282648
show ga
Brain metastases (BMs) occur in 10% to 20% of adult patients with cancer, and
with increased surveillance and improved systemic control, the incidence is
likely to grow. Despite multimodal treatment, prognosis remains poor. Current
evidence supports use of whole-brain radiation therapy when patients present with
multiple BMs. However, its associated cognitive impairment is a major deterrent
in patients likely to live longer than 6 months. In patients with oligometastases
(one to three metastases) and even some with multiple lesions less than 3 to 4
cm, especially if the primary tumor is considered radiotherapy resistant,
stereotactic radiosurgery is recommended; if the BMs are greater than 4 cm,
surgical resection with or without postoperative whole-brain radiation therapy
should be considered. There is increasing evidence that systemic therapy,
including targeted therapy and immunotherapy, is effective against BM and may be
an early choice, especially in patients with sensitive primary tumors. In
patients with progressive systemic disease, limited treatment options, and poor
performance status, best supportive care may be appropriate. Regardless of
treatment goals, use of corticosteroids or antiepileptic medications is helpful
in symptomatic patients. In this review, we provide a summary of current therapy,
as well as developments in the treatment of BM from solid tumors.
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