Brain metastasis and treatment

Abstract

Despite major therapeutic advances in the management of patients with systemic malignancies, management of brain metastases remains a significant challenge. These patients often require multidisciplinary care that includes surgical resection, radiation therapy, chemotherapy, and targeted therapies. Complex decisions about the sequencing of therapies to control extracranial and intracranial disease require input from neurosurgeons, radiation oncologists, and medical/neuro-oncologists. With advances in understanding of the biology of brain metastases, molecularly defined disease subsets and the advent of targeted therapy as well as immunotherapeutic agents offer promise. Future care of these patients will entail tailoring treatment based on host (performance status and age) and tumor (molecular cytogenetic characteristics, number of metastases, and extracranial disease status) factors. Considerable work involving preclinical models and better clinical trial designs that focus not only on effective control of tumor but also on quality of life and neurocognition needs to be done to improve the outcome of these patients.

Management of Brain Metastases from Solid Tumors

“…Nevertheless, SAСT may be an effective treatment option for patients with BM, because it prolongs overall survival, especially in patients with metastatic lesions in other organs, since the progression of extracranial metastases is a common cause of death of most patients [20]. The BBB is a natural barrier for most anticancer drugs, and it is the primary mechanism responsible for BM resistance to systemic therapy.…”

Brain Tumor Imaging

“…In general, the prognosis for patients with metastatic tumors of the CNS is unfavorable. The incidence of brain metastasis is increasing due to improved systemic therapies with sometimes limited CNS activity (Ahluwalia et al 2014).…”

“…All therapeutic considerations regarding brain metastases must account for the systemic situation of the underlying cancer entity (Ahluwalia et al 2014). Neurosurgical resections can be considered in patients with solitary or singular brain metastases and lesions causing mass effects or neurological symptoms (Patchell et al 1990).…”

“…Therefore, WBRT can be postponed in patients where all brain metastases can be sufficiently treated with a local treatment modality (surgery or radiosurgery). Systemic chemotherapy is frequently applied according to the underlying cancer type (Ahluwalia et al 2014). Usually, systemic chemotherapy does not render one of the aforementioned braindirected therapies unnecessary.…”

Immuno-radiotherapy for brain metastases

“…Different outcomes have been shown in multiple studies in patients stratified with different prognostic scoring systems: most of them have some limitations considering primarily age, KPs and number of BM in multiple primary subsytes. The role of genetic signature and other tumor-related features in BM remains unclear [1][2][3][4].…”