Brain Metastases: A Modern Multidisciplinary Approach

Abstract

Brain metastases (BM) are the most common intracranial neoplasm and represent a major clinical challenge across many medical disciplines. The incidence of BM is increasing, largely due to improvements in primary disease therapeutics conferring greater systemic control, and advancements in neuroimaging techniques and availability leading to earlier diagnosis. In recent years, the landscape of BM treatment has changed significantly with the advent of personalized targeted chemotherapies and immunotherapy, the adoption of focal radiotherapy (RT) for higher intracranial disease burden, and the implementation of new surgical strategies. The increasing permutations of options available for the treatment of patients diagnosed with BM necessitate coordinated care by a multidisciplinary team. This review discusses the current treatment regimens for BM as well as examines the salient features of a modern multidisciplinary approach.

Automated Detection of Brain Metastases on T1‐Weighted MRI Using a Convolutional Neural Network: Impact of Volume Aware Loss and Sampling Strategy

“…39 The neural network was trained using the Adam optimizer with a learning rate of 1e-3, which was scheduled to be multiplied by a factor of 0.5 each time the training loss stabilized for more than 50 epochs. Each epoch, five patches of shape 128 3 were sampled from each volume, randomly shuffled and queued to train the model. Each model was trained for 400 epochs over an average of 2 days on a 16-core computer with 64 Gb of RAM and a Nvidia Tesla P4 GPU with 8 Gb of memory.…”

“…2 Current treatment options include symptom management, systemic therapy, radiosurgery (SRS), whole-brain radiotherapy (WBRT; with or without memantine; with or without hippocampal sparing), and surgical resection. 3,4 In institutions where both treatment options are available, SRS has surpassed WBRT as the most common treatment of BM. 5,6 While delivering high doses of radiation precisely to the BM site, it causes fewer side effects than WBRT.…”

“…The incidence of new cases in the United States alone is estimated between 70,000 and 400,000 per annum 2 . Current treatment options include symptom management, systemic therapy, radiosurgery (SRS), whole‐brain radiotherapy (WBRT; with or without memantine; with or without hippocampal sparing), and surgical resection 3,4 …”

Prognostic Factors and Independent Validation of a Risk Stratification Model in Octogenarian Patients Irradiated for Brain Metastases

“…While brain metastases may cause clinical symptoms with potentially serious consequences for patients' ability to carry out activities of daily living irrespective of chronological age, their impact on self-care and cognitive functioning is often more pronounced in the geriatric cancer patient population (1,2). Due to age, frailty and comorbidity even moderate additional deficits may result in immobilization, hospitalization, need for nursing home care, termination of systemic anticancer treatment etc.…”

Level I Evidence Should not be Equated to Standard of Care for Brain Metastases

“…In this issue, O'Halloran et al 1 have written a comprehensive review of current and upcoming management options for brain metastases. The goal of this editorial is to provide a pragmatic neurosurgical perspective on this matter.…”