Brain metastases

Abstract

Metastatic tumors to the brain are an increasing cause of morbidity and mortality in patients with systemic cancers. Many new therapies used to treat systemic cancers do not penetrate the central nervous system (CNS) and do not protect patients from the development of brain metastases. Surgery, radiosurgery, and radiation therapy are all used to treat brain metastases. It is in our opinion a mistake to use only one or two of these modalities to the exclusion of other(s). The role of systemic chemotherapy is still limited, due to both the issues of drug delivery caused by the blood brain barrier and to the relative resistance of many of these tumors to chemotherapy. Traditionally, brain metastases have been grouped together regardless of the origin of the tumor and have been treated with a single algorithm. As we encounter more patients for whom treatment of the brain metastases is an important determinant of survival, we must tailor our treatment strategies to individual tumor types. Also, we must recognize differences in each tumor's sensitivity to chemotherapy and radiotherapy and differences in their biology.

Brain Metastases from Epithelial Ovarian Cancer: A Review of the Literature

“…Stereotactic radiosurgery (SRS) offers an alternative approach in which high doses of focused radiation are delivered by a linear accelerator or by a gamma-knife to the brain metastases [53,54]. Gamma-knife SRS treats CNS lesions without a surgical incision [55].…”

Rapid Manifestation of CNS Metastatic Disease in a Cervical Carcinoma Patient: A Case Report

“…However, some reports have suggested that the incidence is increasing [16]. This may be attributed to the fact that response rates for many systemic chemotherapies have improved, resulting in clinicians detecting recurrent disease in unforeseen sites [9,10,11]. …”

“…The development of innovative chemotherapy agents and inclusion of Gamma Knife stereotactic radiosurgery may further prolong patient survival [9, 11, 15, 20]. Additional study of this disease with regard to diagnosis, treatment efficacy and corresponding survival rates is warranted.…”

“…Following initial diagnosis of the primary disease, the median time to development of CNS metastatic disease is approximately 18 months [4]. Since some studies have suggested that the incidence of CNS metastatic disease is increasing in patients with gynecologic cancer [7,8,9,10], there has been a concerted effort to understand this disease and subsequently develop a more effective treatment [2, 9, 10, 11]. …”

Complete Response of Multiple Melanoma Brain Metastases after Treatment with Temozolomide

“…Brain metastases may also be treated by radiotherapy, either with multiple non-coplanar arcs using a linear accelerator (linac radiosurgery) or with a multi-headed cobalt unit (gamma-knife) [16][17][18][19][20]. The role of chemotherapy has so far been limited in patients with brain metastases of malignant melanoma, partly because of limited chemosensitivity of melanoma, and partly because of difficulties in obtaining therapeutic concentrations of anticancer drugs in the tumor because of the blood-brain barrier [21]. Temozolomide is a novel oral alkylating agent effective in metastatic melanoma [22].…”