A systematic approach to the management of patients with brain metastases of known or unknown primary site

• Published in: Cancer chemotherapy and pharmacology 2012, Vol.69 (1), p.1-13
• Main Authors: Kyritsis, Athanassios P., Markoula, Sofia, Levin, Victor A.
• Format: Article
• Language: English
• Subjects: Antineoplastic agents; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Brain Neoplasms - therapy; Cancer Research; Combined Modality Therapy; Humans; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Medical sciences; Medicine; Medicine & Public Health; Mini Review; Neoplasm Recurrence, Local; Neoplasms - pathology; Neoplasms - therapy; Neoplasms, Unknown Primary - pathology; Neoplasms, Unknown Primary - therapy; Neurology; Oncology; Pharmacology. Drug treatments; Pharmacology/Toxicology; Small Cell Lung Carcinoma - pathology; Small Cell Lung Carcinoma - therapy; Tumors of the nervous system. Phacomatoses
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-011-1775-9

Purpose To establish an empirical systematic approach for the management of brain metastases from a variety of cancers. Methods The English literature was reviewed from 2000 to 2011 and all clinical trials (phase II, phase III and retrospective studies) regarding therapy of brain metastases were selected for more detailed review. Some key articles published prior to 2000 were also included in the review as are supplemental recommendations based on our clinical experience. Results Patients with brain metastases from small cell lung cancer (SCLC) at the initial cancer diagnosis can be treated with concomitant whole-brain radiation therapy (WBRT) and chemotherapy or first with chemotherapy followed by WBRT. In all other cases, brain metastases are currently treated independently of the management of the extracranial disease with surgery or radiosurgery followed by WBRT. In radioresistant tumors (melanoma, sarcoma, renal cell carcinoma), WBRT may be omitted initially but administered at recurrence. Where surgery or radiosurgery is not an option for patients, WBRT should be administered. Prophylactic WBRT should be given in patients with SCLC and considered in patients with non-small cell lung cancer. Apart from its use in SCLC, chemotherapy for the treatment of brain metastases is reserved for patients enrolled in clinical trials. Conclusion Brain metastases should be treated aggressively and independently of the primary site tumor especially if the performance status of the patient is good. The role of chemotherapy should be addressed in the context of clinical trials.