Abstract
Brain metastases are the most common intracranial malignancy, accounting for significant morbidity and mortality in oncology patients. The current treatment paradigm for brain metastasis depends on the patient’s overall health status, the primary tumor pathology, and the number and location of brain lesions. Herein, we review the modern management options for these tumors, including surgical resection, radiotherapy, and chemotherapy. Recent operative advances, such as fluorescence, confocal microscopy, and brachytherapy, are highlighted. With an increased understanding of the pathophysiology of brain metastasis come increased future therapeutic options. Therapy targeted to specific tumor molecular pathways, such as those involved in blood–brain barrier transgression, cell–cell adhesion, and angiogenesis, are also reviewed. A personalized plan for each patient, based on molecular characterizations of the tumor that are used to better target radiotherapy and chemotherapy, is undoubtedly the future of brain metastasis treatment.
Highlights
The Current and Future Treatment of Brain MetastasesDepartment of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA Reviewed by: Hiroki Toda, Kitano Hospital, Japan Kareem Zaghloul, National Institute of Neurological Disorders and Stroke, USA Specialty section: This article was submitted to Neurosurgery, a section of the journal
200,000 patients are newly diagnosed with brain metastases annually in the United States, and metastases of the lung, skin, kidney, breast, and gastrointestinal tract are the most common intracranial malignancies [1, 2]
Current treatment paradigms for brain metastases employ several treatment modalities, including open surgical resection, Gamma Knife or CyberKnife stereotactic radiosurgery, focused external beam radiotherapy, whole-brain radiotherapy (WBRT), traditional chemotherapy, and newer targeted biological agents personalized for tumor type
Summary
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA Reviewed by: Hiroki Toda, Kitano Hospital, Japan Kareem Zaghloul, National Institute of Neurological Disorders and Stroke, USA Specialty section: This article was submitted to Neurosurgery, a section of the journal
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