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Overview of the treatment of brain metastases

Authors
Jay S Loeffler, MD
Patrick Y Wen, MD
Section Editor
Lisa M DeAngelis, MD, FAAN, FANA
Deputy Editor
April F Eichler, MD, MPH

INTRODUCTION

Metastases are the most common intracranial tumors in adults, accounting for more than one-half of all intracranial tumors. The primary approaches to the treatment of brain metastases include surgery, stereotactic radiosurgery (SRS), and whole brain radiation therapy (WBRT).

Treatment of brain metastases has become increasingly individualized as surgical and radiosurgical techniques have evolved over the past several decades, and as improved systemic therapies have begun to offer greater potential for both systemic and intracranial disease control for certain cancer types and genotypes.

While WBRT remains the primary treatment modality for patients with a high intracranial tumor burden, the routine role of WBRT as adjunctive therapy in patients who are candidates for SRS or surgical resection has evolved as randomized trials have shown that despite improved rates of intracranial disease control, adjunctive WBRT does not improve overall survival and may decrease quality of life due to side effects and neurocognitive decline.

The etiology, clinical manifestations, and diagnosis of brain metastases are discussed elsewhere. Management of brain metastases in patients with melanoma and breast cancer are also reviewed separately. (See "Epidemiology, clinical manifestations, and diagnosis of brain metastases" and "Management of brain metastases in breast cancer" and "Management of brain metastases in melanoma".)

PROGNOSTIC ASSESSMENT

Untreated, the median survival of patients with brain metastases from solid tumors is approximately one to two months. In randomized trials composed primarily of patients with non-small cell lung cancer (NSCLC) and breast cancer, the median survival in patients treated with whole brain radiation therapy (WBRT) ranges from four to six months [1-3].

                                  

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 10 00:00:00 GMT+00:00 2016.
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