title: Evolution of multidisciplinary brain metastasis management: case study and literature review.
abstract: Up to 40 percent of all cancer patients develop brain metastasis (BM) during the course of their disease. Despite advances in diagnosis and therapy, prognosis in patients with BM remains poor for many patients, but for some, survival can be of the order of several years in duration. Difficulty in predicting long-term survivors has created controversy in contemporary management of BM. Minimizing medical and neurocognitive side effects (disease borne or iatrogenic) to enhance functional independence and improving overall quality of life in these individuals requires a coordinated approach of first-line and salvage surgical, chemotherapeutic (cytotoxic, targeted, or immune based), and radiation (whole brain radiotherapy or stereotactic radiosurgery) modalities. This goal needs to be balanced against the more traditional targets of management such as symptom relief, reducing tumor burden, and local tumor control, thereby increasing progression-free survival. This case study and literature review demonstrates the role of various treatment modalities in the management of BM.
authors.affiliation: Department of Therapeutic Radiology, Yale-New Haven Hospital and Yale School of Medicine, New Haven, Connecticut.
authors.forename: Rovel
authors.initials: R
authors.lastname: Colaco
authors.affiliation: Department of Neurosurgery, Yale-New Haven Hospital and Yale School of Medicine, New Haven, Connecticut.
authors.forename: Pierre
authors.initials: P
authors.lastname: Martin
authors.affiliation: Department of Neurosurgery, Yale-New Haven Hospital and Yale School of Medicine, New Haven, Connecticut.
authors.forename: Veronica
authors.initials: V
authors.lastname: Chiang
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D019090:Case Management; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D010348:Patient Care Team; D016634:Radiosurgery / Q000379:methods; D016896:Treatment Outcome
keywords: brain metastasis; chemotherapy; cytotoxic chemotherapy; immunotherapy; neurosurgery; stereotactic radiosurgery; whole brain radiotherapy