Current management of brain metastases, with a focus on systemic options.
Brain metastases are an important sequelae of many types of cancer, most commonly lung cancer. Current treatment options include whole-brain radiation therapy (WBRT), surgical resection, stereotactic radiosurgery, and chemotherapy. Corticosteroids and antiepileptic medications are commonly used for palliation of mass effect and seizures, respectively. The overall median survival is only 4 months after WBRT. Combined-modality strategies of WBRT with either chemotherapy or novel anticancer agents are under clinical investigation. Promising results have been obtained with several experimental agents and confirmatory phase III trials are underway. Although improvement in overall survival has not been seen universally, reduction in death due to progression of brain metastases and prolongation of the time to neurologic and neurocognitive progression have been reported in selected series. On the basis of these findings, it might be possible to identify new agents that may enhance the efficacy of WBRT.
Langer
Corey J
CJ
Division of Thoracic Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA. CJ_Langer@fccc.edu
Mehta
Minesh P
MP
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications / Q000556:secondary* / Q000628:therapy*; D017326:Clinical Trials, Phase III as Topic; D003072:Cognition Disorders / Q000209:etiology; D016371:Cranial Irradiation; D006801:Humans; D010166:Palliative Care; D011379:Prognosis; D016634:Radiosurgery; D012640:Seizures / Q000209:etiology; D013534:Survival
D000305:Adrenal Cortex Hormones; D000927:Anticonvulsants; D000970:Antineoplastic Agents