Intracranial Metastatic Disease: Present Challenges, Future Opportunities

Abstract

Intracranial metastatic disease (IMD) is a prevalent complication of cancer that significantly limits patient survival and quality of life. Over the past half-century, our understanding of the epidemiology and pathogenesis of IMD has improved and enabled the development of surveillance and treatment algorithms based on prognostic factors and tumor biomolecular characteristics. In addition to advances in surgical resection and radiation therapy, the treatment of IMD has evolved to include monoclonal antibodies and small molecule antagonists of tumor-promoting proteins or endogenous immune checkpoint inhibitors. Moreover, improvements in the sensitivity and specificity of imaging as well as the development of new serological assays to detect brain metastases promise to revolutionize IMD diagnosis. In this review, we will explore current treatment principles in patients with IMD, including the emerging role of targeted and immunotherapy in select primary cancers, and discuss potential areas for further investigation.

Personalized radiotherapy of brain metastases: survival prediction by means of dichotomized or differentiated blood test results?

“…Brain metastases should not be regarded as universally fatal cancer manifestation anymore (1)(2)(3)(4). Even if survival outcomes of less than one year are still common, especially in patients with large burden of extracranial metastases who lack effective systemic treatment options (5), survival beyond 5 or even 10 years can be achieved in a minority of patients (6)(7)(8).…”

“…Better understanding of factors explaining these survival differences has led to prognostic scores, which might aid clinicians who have to choose between vastly different treatment options. The latter include surgical resection, radiosurgery, other radiotherapy, systemic treatment and best supportive care, if other approaches are unlikely to prolong survival or improve quality of life (1)(2)(3)(4).…”

Diabetes Mellitus Is a Strong Independent Negative Prognostic Factor in Patients with Brain Metastases Treated with Radiotherapy

“…According to a SEER database analysis among patients with metastatic disease, patients with melanoma (28.2%), lung adenocarcinoma (26.8%), small cell lung cancer (23.5%), squamous cell carcinoma of the lung (15.9%), renal cancer (10.8%) and breast cancer (7.6%) had brain metastases [1]. Importantly, the incidence of brain metastases (BM) is increasing, partially due to longer life expectancy and better means of detection [2,3].…”

Long-term survival in patients with brain metastases—clinical characterization of a rare scenario

“…Brain metastases (BM) are frequent complications in patients with advanced solid tumors [1][2][3]. The propensity for metastatic spread to the brain varies widely among tumor types, being highest among patients with lung cancer [3][4][5].…”