Management of brain metastases: history and the present

Abstract

Brain metastases are significant causes of morbidity or mortality for patients with metastatic cancer. With the application of novel systematic therapy and improvement of overall survival, the prevalence of brain metastases is increasing. The paradigm of treatment for brain metastases evolved rapidly during the last 30 years due to the development of technology and emergence of novel therapy. Brain metastases used to be regarded as the terminal stage of cancer and left life expectancy to only 1 month. The application of whole brain radiotherapy for patients with brain metastases increased the life expectancy to 4-6 months in the 1980s. Following studies established surgical resection followed by the application of whole brain radiotherapy the standard treatment for patients with single metastasis and good systematic performance. With the development of stereotactic radiosurgery, stereotactic radiosurgery plus whole brain radiotherapy provides an alternative modality with superior neurocognitive protection at the cost of overall survival. In addition, stereotactic radiosurgery combined with whole brain radiotherapy may offer a promising modality for patients with numerous multiple brain metastases who are not eligible for surgical resection. With the advancing understanding of molecular pathway and biological behavior of oncogenesis and tumor metastasis, novel targeted therapy including tyrosine-kinase inhibitors and immunotherapy are applied to brain metastases. Clinical trials had revealed the efficacy of targeted therapy. Furthermore, the combination of targeted therapy and radiotherapy or chemotherapy is the highlight of current investigation. Advancement in this area may further change the treatment paradigm and offer better modality for patients who are not suitable for surgical resection or radiosurgery.

Clinical Outcomes of Large (>10 mm) Unruptured Posterior Circulation Aneurysms and Their Predictors

“…There has been relentless debate over the superiority of transcranial surgery or EVT for intracranial aneurysm. In a recent meta-analysis, Tsianaka et al [ 12 ] reported no superiority between transcranial surgery and EVT in the treatment of posterior circulation aneurysm. However, their report lacked a subgroup analysis for large posterior circulation aneurysms [ 12 ].…”

“…In the endovascular era, many clinicians have advocated the use of EVT to treat posterior circulation aneurysm [ 6 , 9 , 12 ]. In our series, more than 60% of patients were treated by EVT, and the complete obliteration and post-treatment complication rates of EVT were comparable to those of transcranial surgery.…”

“…When it comes to the recurrence rate of aneurysms, there was a difference between transcranial surgery and EVT in our series, with the recurrence rate of EVT being higher than that of transcranial surgery (39.5% vs 11.1%, p =0.03). Tsianaka et al [ 12 ] also reported a high recurrence rate for EVT in posterior circulation aneurysms. In our experience, when it comes to the durability of treatment, transcranial surgery is better than EVT in large unruptured posterior circulation aneurysms.…”

Radiotherapeutic management of brain tumours during the COVID-19 pandemic

“…The treatment decision-making algorithm proposed during the COVID-19 pandemic is given in Figure 1. The suggested treatment options for brain tumours [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] are enlisted in Table 1.…”

A real-world study in advanced non-small cell lung cancer with de novo brain metastasis

“…Brain metastases are the major cause of the poor prognosis and quality of life in all metastatic cancer patients 1 , 2 , especially in advanced non-small cell lung cancer (NSCLC) 3 . About 10-35% of the NSCLC patients have de novo BM on the diagnosis of lung cancer, and more than 50% of patients would develop BM during the treatment course 4 , 5 .…”