title: Management of metastatic (parenchymal, leptomeningeal, and epidural) lesions.
abstract: OBJECTIVE
  Metastases involving the central nervous system are notorious for the functional neurologic deficits they often cause. For many patients, the overall prognosis is determined by the systemic disease status, but a subset of patients may benefit from more intensive treatment.
  
  
  RESULTS
  Patients in a subgroup with brain metastases qualify for more intensive treatments, like stereotactic radiosurgery, the efficacy of which seems to be similar to that of surgery for single brain metastases. Although whole brain radiotherapy after stereotactic radiosurgery decreases the outfield recurrences, there are no indications that it improves survival. So far, studies on radiosensitizers have not resulted in clear evidence of improved outcome for good prognosis in patients with brain metastases. A variety of surgical procedures offer better palliation for a subset of patients with epidural spinal metastases than radiotherapy alone. The roles of the blood-brain barrier and of the blood-cerebrospinal fluid barrier remain a source of discussion. It may be relevant for patients with micrometastases, which can potentially be cured by systemic treatment.
  
  
  CONCLUSIONS
  For many patients with central nervous system complications, adequate palliation can be achieved, but this requires rapid and thorough evaluation of patients with central nervous system symptoms. Early diagnosis and proper patient selection for further and more intensive treatment are the cornerstones of good palliative care in these patients.
authors.affiliation: Neuro-Oncology Unit, Daniel den Hoed Oncology Center, Erasmus University Hospital, Rotterdam, The Netherlands. m.vandenbent@erasmusmc.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: van den Bent
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000493:pharmacokinetics; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000378:metabolism; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy*; D002986:Clinical Trials as Topic; D019468:Disease Management; D015174:Epidural Neoplasms / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D008577:Meningeal Neoplasms / Q000556:secondary* / Q000628:therapy*; D009362:Neoplasm Metastasis; D013117:Spinal Cord Compression / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents