Novel insights into the management of brain metastases

Abstract

This review provides available clinical evidence regarding current therapies, discusses ongoing controversies, and introduces investigational approaches in the management of brain metastases. Novel approaches to estimating prognosis of patients with brain metastases highlight the importance of tailoring treatment to each particular patient. In the setting of unfavorable prognosis, either hospice care, symptom management, or short-course whole-brain radiotherapy (WBRT) is a critical component of palliation. In the setting of favorable or intermediate prognosis, treatment options can include a slightly more prolonged course of WBRT, surgery, stereotactic radiosurgery, systemic therapy, or a combination. Selection of the appropriate treatment is influenced by the number of brain metastases, overall patient performance status and residual life expectancy, as well as an understanding of the benefits and toxicities of each modality. Recent clinical studies have shed novel insight on the temporal sequence of memory changes following WBRT. Innovative approaches to mitigating these radiation-induced memory effects are currently being investigated. Evidence-based management of brain metastases represents an evolving field of active clinical research. Ongoing and future investigations focus on the preservation of cognition and quality of life, in addition to conventional outcomes such as intracranial tumor control and survival.