Authors: Tobias Walbert Mark R Gilbert
Publish Date: 2009/08/25
Volume: 14, Issue: 4, Pages: 299-306
Abstract
Brain metastases are the most frequent cancer in the central nervous system being ten times more common than primary brain tumors Patients generally have a poor outcome with a median survival of 4 months after diagnosis of the metastases Therapeutic options include surgery stereotactic radiosurgery wholebrain radiotherapy WBRT and chemotherapy Patients with a limited number of brain metastases and wellcontrolled systemic cancer benefit from brain metastasesspecific therapies including surgery radiosurgery and conventional radiation The role of chemotherapy for brain metastases remains limited There is concern about drug delivery because of the bloodbrain barrier However higher response rates are noted with initial therapies suggesting that part of the poor response rate may be related to the late onset of brain metastases and the use of second and thirdline regimens Recent studies have demonstrated objective responses with systemic therapy in a variety of cancer types especially when combined with WBRT Individual therapeutic strategies for central nervous system metastases must be chosen based on performance status the extent of intracranial disease and the chemosensitivity of the underlying tumor as well as the control of the systemic cancer In this article we review important prognostic factors and challenges in using chemotherapy We specifically review recent advances in the treatment of brain metastases from breast and lung cancer as well as melanoma Future treatment advances will require a multidisciplinary approach integrating surgical radiation and chemotherapeutic options to improve neurological function and quality of life rather than just focusing on survival endpoints
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