title: Brain metastases:  what's new with an old problem?
abstract: OBJECTIVE
  To summarize developments in the management of brain metastases over the past decade.
  
  
  RESULTS
  A few randomized trials have been published during the past decade examining the use of whole brain radiotherapy (WBRT) and radiosurgery (SRS) boost versus WBRT alone. Other recent trials have been published examining the use of SRS alone versus SRS and WBRT.There continues to be neither a role for the routine use of chemotherapy (excluding patients with metastatic seminoma to brain) nor radiosensitizers in the management of patients with brain metastases.
  
  
  CONCLUSIONS
  The management options for selected patients with brain metastases today include steroids (to treat brain edema), anticonvulsants (to treat seizures), WBRT, surgery (for single brain metastasis) and radiosurgery (SRS), either alone or in combination. Survival, local metastasis control, overall brain control, and neuro-cognitive outcomes should influence management. New therapeutic areas of research for brain metastases include defining the role of conventional and novel chemotherapy and targeted agents, radiation sensitizers, and stem cell-associated therapies either alone or in combination with various forms of radiation, as well as decreasing radiation morbidities, using drugs or technology.
authors: Department Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada.
authors: May N
authors: MN
authors: Tsao
authors: Deepak
authors: D
authors: Khuntia
authors: Minesh P
authors: MP
authors: Mehta
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001921:Brain / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D006801:Humans; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D033581:Stem Cell Transplantation; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D000975:Antioxidants; D011838:Radiation-Sensitizing Agents; D013256:Steroids