Current management of metastatic brain disease |
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Authors: | Tulika Ranjan Lauren E Abrey |
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Institution: | 1. Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, 10065, New York, NY
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Abstract: | Brain metastases are the most common intracranial tumor in adults. The incidence of metastases is thought to be rising due
to better detection and treatment of systemic malignancy. More widespread use and improved quality of MRI may lead to early
detection of brain metastases. Available evidence suggests that survival is longer and quality of life improved if brain metastases
are treated aggressively. This article reviews current therapeutic management used for brain metastases. To select the appropriate
therapy, the physician must consider the extent of the systemic disease, primary histology, and patient age and performance
status, as well as the number, size, and location of the brain metastases. Available treatment options include whole-brain
radiotherapy (WBRT), stereotactic radiosurgery (SRS), surgery, and chemotherapy. Multidisciplinary approaches such as the
combination of WBRT with SRS or surgery have shown superior results in terms of survival time, neurocognitive function, and
quality of life. The utility and optimal use of chemotherapy and radiosensitizing agents is less clear. It is hoped that further
advances and multidisciplinary approaches currently under study will result in improved patient outcomes. |
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