title: [Treatment of brain metastases].
abstract: The treatment of metastastic disease to the brain requires integration of neurosurgical, radiotherapeutic and oncological principles. Surgical resection is mandatory if a brain tumor manifests as an apparently unifocal lesion of a newly discovered neoplastic disorder. Furthermore, surgery is to be selected to alleviate signs and symptoms of increased intracranial pressure which can be caused by a mass effect and/or by obstruction of the CSF pathways. With regard to local tumor control of a single brain metastasis, resection followed by whole brain irradiation has proven superior to radiotherapy alone. Alternatively, a brain metastasis with a diameter of less than 3 cm can also be treated with Gamma-knife radio-surgery, a therapeutic modality that has also proven valuable in the control of multiple brain metastases and for local control following resection. Sometimes, local control can also be improved with a boost of conventional external beam radiotherapy onto a pre-irradiated site. Multiple brain metastases with lesions displaying a diameter of more than 3 cm not well suited for resection can also be treated with whole brain radiotherapy. Occasionally, a chemoresponsive tumor can be controlled with cytotoxic drugs. In conclusion, a carefully tailored therapeutic strategy can be very rewarding for both the patient and the specialists involved that definitively improves the quality of life by extending progression-free survival.
authors.affiliation: Klinik für Neurochirurgie, Universitätsspitäler Basel.
authors.forename: M
authors.initials: M
authors.lastname: Koehler
authors.forename: A
authors.initials: A
authors.lastname: Merlo
mesh_terms: D000328:Adult; D000465:Algorithms; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010166:Palliative Care; D018579:Patient Selection; D011379:Prognosis; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant