Brain metastases: An update on the multi-disciplinary approach of clinical management |
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| Affiliation: | 1. Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53792, USA;2. Department of Neurosurgery, Indiana University School of Medicine, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA;3. Department of Medicine/Hematology Oncology, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, USA;1. Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Germany;2. Department for Radiation Oncology, Martin-Luther University Halle-Wittenberg, Halle, Germany;3. Skin Cancer Center, Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany;4. Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany;5. Department of Radiology, University Hospital Regensburg, Regensburg, Germany;6. Department of Dermatology, University Hospital Essen, Essen, Germany;7. Bristol-Myers Squibb GmbH & Co. KGaA, Munich, Germany;8. Policlinic for Radiation Therapy and Radiation Oncology, University Hospital Göttingen, Göttingen, Germany;9. Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany;10. Department of Dermatology, Medical University Vienna, Vienna, Austria;11. Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany;12. Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases, Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany;1. Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA;2. MacFeeters-Hamilton Center for Neuro-Oncology Research, Princess Margaret Cancer Center, 14-701, Toronto Medical Discovery Tower (TMDT), 101 College Street, Toronto, Ontario M5G 1L7, Canada;3. Section of Medical Oncology-WWW211, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA;1. Brain Metastasis Group, Spanish National Cancer Research Center (CNIO), Melchor Fernández Almagro 3, Madrid, Spain;2. Brain Metastasis Research Program, Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Medicine, Cleveland Clinic, Neurological Institute, 9500 Euclid Avenue, 44195 Cleveland, OH, USA;3. Department of Neurology, Human Oncology and Pathogenesis Program, Brain Tumor Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065 New York, NY, USA;4. Division of Hematology/Oncology, Department of Medicine; Division of Neuro-Oncology, Department of Neurology; Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, 02114 Boston, MA, USA;5. Department of Medicine (Medical Oncology), Yale School of Medicine, 333 Cedar Street, New Haven, CT, USA;6. Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, 02215 Boston, MA, USA;7. Neuro-Oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Rue Emile Laine, 59037 Lille, France;8. Neurology, Department of Medical Oncology, Oscar Lambret Center, 59020 Lille, France;9. Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 1192, Villeneuve d’Ascq, France;10. Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland;11. Department of Medicine I, Comprehensive Cancer Center Vienna, CNS Unit (CCC-CNS), Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria;12. Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, and Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany;13. Department of Neuro-Oncology, University Hospital Turin, Via Cherasco 15, 10126 Turin, Italy |
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| Abstract: | ImportanceBrain metastasis (BM) is the most common malignant intracranial neoplasm in adults with over 100,000 new cases annually in the United States and outnumbering primary brain tumors 10:1.ObservationsThe incidence of BM in adult cancer patients ranges from 10-40%, and is increasing with improved surveillance, effective systemic therapy, and an aging population. The overall prognosis of cancer patients is largely dependent on the presence or absence of brain metastasis, and therefore, a timely and accurate diagnosis is crucial for improving long-term outcomes, especially in the current era of significantly improved systemic therapy for many common cancers. BM should be suspected in any cancer patient who develops new neurological deficits or behavioral abnormalities. Gadolinium enhanced MRI is the preferred imaging technique and BM must be distinguished from other pathologies. Large, symptomatic lesion(s) in patients with good functional status are best treated with surgery and stereotactic radiosurgery (SRS). Due to neurocognitive side effects and improved overall survival of cancer patients, whole brain radiotherapy (WBRT) is reserved as salvage therapy for patients with multiple lesions or as palliation. Newer approaches including multi-lesion stereotactic surgery, targeted therapy, and immunotherapy are also being investigated to improve outcomes while preserving quality of life.ConclusionWith the significant advancements in the systemic treatment for cancer patients, addressing BM effectively is critical for overall survival. In addition to patient's performance status, therapeutic approach should be based on the type of primary tumor and associated molecular profile as well as the size, number, and location of metastatic lesion(s). |
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| Keywords: | Brain metastasis Cancer Radiation Neurosurgery Chemotherapy Lung cancer |
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