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A systematic approach to the management of patients with brain metastases of known or unknown primary site
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 sel...
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| Published in: | Cancer chemotherapy and pharmacology 2012, Vol.69 (1), p.1-13 |
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| container_title | Cancer chemotherapy and pharmacology |
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| creator | Kyritsis, Athanassios P. Markoula, Sofia Levin, Victor A. |
| description | 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. |
| doi_str_mv | 10.1007/s00280-011-1775-9 |
| format | article |
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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.</description><identifier>ISSN: 0344-5704</identifier><identifier>EISSN: 1432-0843</identifier><identifier>DOI: 10.1007/s00280-011-1775-9</identifier><identifier>PMID: 22042515</identifier><identifier>CODEN: CCPHDZ</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>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</subject><ispartof>Cancer chemotherapy and pharmacology, 2012, Vol.69 (1), p.1-13</ispartof><rights>Springer-Verlag 2011</rights><rights>2015 INIST-CNRS</rights><rights>Springer-Verlag 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-7c848e9706f6a6f2f32e63a3040269f46411bd4f322f18449d75ff3502cdbf4b3</citedby><cites>FETCH-LOGICAL-c400t-7c848e9706f6a6f2f32e63a3040269f46411bd4f322f18449d75ff3502cdbf4b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25577346$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22042515$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kyritsis, Athanassios P.</creatorcontrib><creatorcontrib>Markoula, Sofia</creatorcontrib><creatorcontrib>Levin, Victor A.</creatorcontrib><title>A systematic approach to the management of patients with brain metastases of known or unknown primary site</title><title>Cancer chemotherapy and pharmacology</title><addtitle>Cancer Chemother Pharmacol</addtitle><addtitle>Cancer Chemother Pharmacol</addtitle><description>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.</description><subject>Antineoplastic agents</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - secondary</subject><subject>Brain Neoplasms - therapy</subject><subject>Cancer Research</subject><subject>Combined Modality Therapy</subject><subject>Humans</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - therapy</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mini Review</subject><subject>Neoplasm Recurrence, Local</subject><subject>Neoplasms - pathology</subject><subject>Neoplasms - therapy</subject><subject>Neoplasms, Unknown Primary - pathology</subject><subject>Neoplasms, Unknown Primary - therapy</subject><subject>Neurology</subject><subject>Oncology</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacology/Toxicology</subject><subject>Small Cell Lung Carcinoma - pathology</subject><subject>Small Cell Lung Carcinoma - therapy</subject><subject>Tumors of the nervous system. Phacomatoses</subject><issn>0344-5704</issn><issn>1432-0843</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNp1kU1r3DAQhkVpaLZpf0AvRRRKT05H0tiyjyGkHxDIpT0LWStlvV3LW41MyL-PjLcNFApCGjTPfL6MvRNwKQD0ZwKQLVQgRCW0rqvuBdsIVLKCFtVLtgGFWNUa8Jy9JtoDAAqlXrFzKQFlLeoN219xeqTsR5sHx-3xmCbrdjxPPO88H2209370MfMp8GNhikn8Ycg73ic7RD76bKkcTwvxK04PkU-Jz3E1j2kYbXrkNGT_hp0FeyD_9vResJ9fbn5cf6tu775-v766rRwC5Eq7FlvfaWhCY5sgg5K-UVYBgmy6gA0K0W-xfMsgWsRuq-sQVA3SbfuAvbpgn9a8ZZbfs6dsxoGcPxxs9NNMphMKVadVW8gP_5D7aU6xNLdAoinXAokVcmkiSj6Y01BGgFlkMKsMpshgFhlMV2LenxLP_ei3fyP-7L0AH0-AJWcPIdnoBnrm6lprhU3h5MpRccV7n547_H_1J5W2n04</recordid><startdate>2012</startdate><enddate>2012</enddate><creator>Kyritsis, Athanassios P.</creator><creator>Markoula, Sofia</creator><creator>Levin, Victor A.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>2012</creationdate><title>A systematic approach to the management of patients with brain metastases of known or unknown primary site</title><author>Kyritsis, Athanassios P. ; Markoula, Sofia ; Levin, Victor A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-7c848e9706f6a6f2f32e63a3040269f46411bd4f322f18449d75ff3502cdbf4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Antineoplastic agents</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - secondary</topic><topic>Brain Neoplasms - therapy</topic><topic>Cancer Research</topic><topic>Combined Modality Therapy</topic><topic>Humans</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - therapy</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mini Review</topic><topic>Neoplasm Recurrence, Local</topic><topic>Neoplasms - pathology</topic><topic>Neoplasms - therapy</topic><topic>Neoplasms, Unknown Primary - pathology</topic><topic>Neoplasms, Unknown Primary - therapy</topic><topic>Neurology</topic><topic>Oncology</topic><topic>Pharmacology. Drug treatments</topic><topic>Pharmacology/Toxicology</topic><topic>Small Cell Lung Carcinoma - pathology</topic><topic>Small Cell Lung Carcinoma - therapy</topic><topic>Tumors of the nervous system. Phacomatoses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kyritsis, Athanassios P.</creatorcontrib><creatorcontrib>Markoula, Sofia</creatorcontrib><creatorcontrib>Levin, Victor A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer chemotherapy and pharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kyritsis, Athanassios P.</au><au>Markoula, Sofia</au><au>Levin, Victor A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A systematic approach to the management of patients with brain metastases of known or unknown primary site</atitle><jtitle>Cancer chemotherapy and pharmacology</jtitle><stitle>Cancer Chemother Pharmacol</stitle><addtitle>Cancer Chemother Pharmacol</addtitle><date>2012</date><risdate>2012</risdate><volume>69</volume><issue>1</issue><spage>1</spage><epage>13</epage><pages>1-13</pages><issn>0344-5704</issn><eissn>1432-0843</eissn><coden>CCPHDZ</coden><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22042515</pmid><doi>10.1007/s00280-011-1775-9</doi><tpages>13</tpages></addata></record> |
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| ispartof | Cancer chemotherapy and pharmacology, 2012, Vol.69 (1), p.1-13 |
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| language | eng |
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| source | Springer Nature |
| 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 |
| title | A systematic approach to the management of patients with brain metastases of known or unknown primary site |
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