Abstract
Brain metastases are a very common neurological sequela in cancer patients. The ability of current anti-cancer therapies to prolong overall survival is beleaguered by this development in the case of a number of different cancers. This review provides a general overview of relevant treatment modalities, highlights major decision strategies used in selecting the optimal treatment algorithm and summarizes important steps necessary before initiating therapy. A PubMed database search was done to identify publications describing the treatment of brain metastases including surgery, radiotherapy and symptomatic care. Patient performance status and extent of disease play the most important roles in selecting between an aggressive or more conservative approach. As several other options are available, treatment decisions should be made in cooperation with multiple medical specialties and the involvement of multidisciplinary teams. In the future, brain metastases could become less of a treatment obstacle than they are today.
Highlights
The therapeutic strategy in the management of brain metastases depends on a number of factors: type of cancer, systemic tumor burden, available systemic treatment options, number and size of metastases and, location and performance status
Owing to marked differences in prognosis for patients with brain metastases due to different tumor types, with advances in new systemic treatment options, the Recursive Partitioning Analysis (RPA) was becoming less accurate over time and the Graded Prognostic Assessment (GPA) was introduced
This study suggested that overall survival is determined mainly by extracranial disease
Summary
Brain metastases are a very common neurological sequela in cancer patients. The ability of current anticancer therapies to prolong overall survival is beleaguered by this development in the case of a number of different cancers. This review provides a general overview of relevant treatment modalities, highlights major decision strategies used in selecting the optimal treatment algorithm and summarizes important steps necessary before initiating therapy. A PubMed database search was done to identify publications describing the treatment of brain metastases including surgery, radiotherapy and symptomatic care. Patient performance status and extent of disease play the most important roles in selecting between an aggressive or more conservative approach. As several other options are available, treatment decisions should be made in cooperation with multiple medical specialties and the involvement of multidisciplinary teams. Brain metastases could become less of a treatment obstacle than they are today.
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