13 - Brain Metastases

Abstract

Brain metastases during the course of a malignant disease are a hallmark of incurable disseminated disease. This chapter describes the management of patients with metastatic disease in the brain parenchyma, diagnosis, prognosis and medical management, and specific treatment modalities. The chapter also discusses the management in common solid tumors, such as small cell lung cancers (SCLC), breast cancer, and germ cell tumors. Management of metastases can be achieved with symptomatic management and a range of oncological treatments, of which whole brain radiotherapy (WBRT) remains the most effective. The chapter suggests that more aggressive treatment approaches with surgery, radiosurgery, and combined therapies are best reserved for a subset of patients with solitary brain metastases, who have minimal neurological deficit and absent or static systemic disease. The intensive local treatments are considered inappropriate for patients with multiple brain metastases, particularly in the context of other metastatic disease. Palliative care services have an important and often primary role in the care of patients affected by brain metastases, as well as their families. The chapter recommends that all patients with brain metastases should be allowed symptom-free independent life at home or in a palliative care setting; the focus must be on support and not oncological treatment alone.