Brain metastases

Edward J Dropcho MD (Dr. Dropcho of Indiana University Medical Center has no relevant financial relationships to disclose.)
Originally released April 7, 1994; last updated May 12, 2013; expires May 12, 2016
Notice: This article has expired and is, therefore, not available for CME credit.

Overview

Metastatic brain tumors arising from systemic cancer affect more than 200,000 people in the United States each year. Brain metastases have a potentially devastating effect on quality of life and patient survival. Recent developments in treatment of patients with brain metastases include stereotactic radiosurgery following surgical resection, molecularly targeted agents, and immunotherapy. The author of this clinical article summarizes the clinical features of brain metastases and provides an updated summary and critique of currently available treatments.

Key points

 

• Metastasis to the brain parenchyma is the single most frequent neurologic complication of several common neoplasms, including lung cancer, breast cancer, and melanoma.

 

• Brain metastases often have a devastating impact on patients' quality of life and are fatal if not controlled.

 

• Treatment options for patients with brain metastases include surgical resection, whole-brain radiation therapy, stereotactic radiosurgery, and in some cases chemotherapy or molecularly targeted therapy.

 

• The management of patients with brain metastases needs to be individualized based on the primary tumor type, number, size, and location of brain metastases, status of the systemic tumor, patients' neurologic and overall performance status, and anticipated duration of survival.

Historical note and terminology

Brain metastases are neoplasms that originate in tissues outside the brain and spread secondarily to involve the brain. Metastases to the brain may be single or multiple. The phrase "single brain metastasis" refers to an apparent single cerebral lesion and makes no implication regarding the extent of cancer elsewhere in the body. The phrase "solitary brain metastasis" is used to describe the relatively rare occurrence of a single brain metastasis that is the only known site of metastatic cancer in the body. Synchronous brain metastases are present at the time of the initial systemic tumor diagnosis, whereas metachronous metastases develop later in the course of patients' disease.

In 1926 Grant reported the first series of patients given surgical treatment for single brain metastases (Grant 1926). Radiation therapy for the palliation of brain metastases was introduced in the 1950s (Chao et al 1954). Stereotactic radiosurgery became widely available in the early 1990s.

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