title: 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.
authors.affiliation: Division of Neurosurgery, University of North Carolina at Chapel Hill, 148 Burnett-Womack Building, Campus Box 7060, Chapel Hill, NC 27599-7060, USA. ewend@med.unc.edu
authors.forename: M G
authors.initials: MG
authors.lastname: Ewend
authors.forename: L A
authors.initials: LA
authors.lastname: Carey
authors.forename: D E
authors.initials: DE
authors.lastname: Morris
authors.forename: R D
authors.initials: RD
authors.lastname: Harvey
authors.forename: T A
authors.initials: TA
authors.lastname: Hensing
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000473:pathology; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003399:Craniotomy; D003952:Diagnostic Imaging; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy; D011379:Prognosis; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D016896:Treatment Outcome