Home Forums Other Specialities Neurology & Neurosurgery TREATMENT OF BRAIN METASTASIS

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    Treatment of Brain Metastases

    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 radio surgery 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 anti epileptic medications is helpful in symptomatic patients.

    AMERICAN SOCIETY OF CLINICAL ONCOLOGY: 17th Aug 2015.

    G Mohan.

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