Brain metastases

The topic of brain metastases has recently become a popular subject for review. The reasons for this most likely include technical advances in therapy, notably radiosurgery, as well as recently-published reports of phase III studies, which have addressed certain aspects of management, notably the combination of surgery and radiotherapy in the treatment of patients with a single metastasis. The main purpose of treatment is to reverse the patient's neurological deficits and prolong life. Nevertheless, opinions remain divided on whether meaningful clinical progress has been achieved overall. A clinician working in a tertiary referral center offering radiosurgery for a selected group of favorable patients may believe that the therapeutic nihilism of the past is no longer warranted, whereas another, whose experience is based on the management of patients dying from metastatic lung cancer, may still question the value of active treatment. The purpose of this review will be to try to reconcile these opinions by providing a critical analysis of the available evidence, identify current problems in management, and suggest future directions for clinical investigation.