Brain metastases: current management and new developments.
OBJECTIVE
To review the state-of-the-art and new developments in the management of patients with brain metastases.


RESULTS
Treatment decisions are based on prognostic factors to maximize neurologic function and survival, while avoiding unnecessary therapies. Whole-brain radiotherapy (WBRT) is the treatment of choice for patients with unfavorable prognostic factors. Stereotactic radiosurgery (SRS) or surgery is indicated for patients with favorable prognostic factors and limited brain disease. In single brain metastasis, the addition of either stereotactic radiosurgery or surgery to WBRT improves survival. The omission of WBRT after surgery or radiosurgery results in a worse local and distant control, though it does not affect survival. The incidence of neurocognitive deficits in long-term survivors after WBRT remains to be defined. New approaches to avoid cognitive deficits following WBRT are being investigated. The role of chemotherapy is limited. Molecularly targeted therapies are increasingly employed. Prophylaxis with WBRT is the standard in small-cell lung cancer.


CONCLUSIONS
Many questions need future trials: the usefulness of new radiosensitizers; the role of local treatments after surgery; and the impact of molecularly targeted therapies on subgroups of patients with specific molecular profiles. Quality of life and cognitive functions are recognized as major endpoints in clinical trials.
Soffietti
Riccardo
R
Division of Neuro-Oncology, Department of Neuroscience and Oncology, University and San Giovanni Battista Hospital, Turin, Italy. riccardo.soffietti@unito.it
Rudà
Roberta
R
Trevisan
Elisa
E
D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D003071:Cognition; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008495:Medical Oncology / Q000379:methods; D009362:Neoplasm Metastasis; D011788:Quality of Life; D016634:Radiosurgery; D011878:Radiotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome