Neurosurgical and Radiosurgical Decisions in Brain Metastasis
Neurosurgical and Radiosurgical Decisions in Brain Metastasis
The incidence of brain metastases (BM) is increasing to date, mostly due to the actual improvement of cancer patient overall survival (OS) with the advent of targeted therapies. BM management has dramatically evolved over the last 15 years and uses varying strategies including more or less aggressive local treatments, sometimes combined with systemic therapies that led to an improvement of patient's survival and quality of life. The therapeutic decision is still a matter of debates among experts during multidisciplinary staff, taking into account established prognostic factors including patient's general condition (clinical and functional status of the patient), extra-cerebral disease status, characteristic of intracranial metastases and clinical and radiological presentation of BM. In this article, we reviewed evidence based data available in the literature on the local treatment of BM.
Brain metastases (BM) represent a major health problem in patients with cancer. It is estimated that approximately 20–40% of patients with malignant neoplasia will develop brain metastasis during their disease. These lesions, whose incidence is increasing due to the improvement of primary cancers management, represent the most frequent intra-axial brain tumors.
Whole-brain radiation therapy (WBRT) has been for a while the standard treatment of BM. However, the advent of modern imaging techniques (CT and MRI), the improvement of surgical techniques and neuroanesthesia, and the positive impact of stereotactic radiotherapy (SRT) [radiosurgery, hypofractionated stereotactic radiotherapy (HSRT)], led to a reappraisal of local treatment modalities in BM management. Therapeutic decision depends on several factors related to tumor characteristics (number, radiological aspect, size, location), patient clinical status (neurological deficit, general condition, comorbidities, performance status) and primary disease status (controlled or uncontrolled, extracranial active metastatic disease).
In this article, we will present an overview of local treatment modalities in BM namely surgical and SRT indication. Respective toxicity of each approach will also be discussed.
Abstract and Introduction
Abstract
The incidence of brain metastases (BM) is increasing to date, mostly due to the actual improvement of cancer patient overall survival (OS) with the advent of targeted therapies. BM management has dramatically evolved over the last 15 years and uses varying strategies including more or less aggressive local treatments, sometimes combined with systemic therapies that led to an improvement of patient's survival and quality of life. The therapeutic decision is still a matter of debates among experts during multidisciplinary staff, taking into account established prognostic factors including patient's general condition (clinical and functional status of the patient), extra-cerebral disease status, characteristic of intracranial metastases and clinical and radiological presentation of BM. In this article, we reviewed evidence based data available in the literature on the local treatment of BM.
Introduction
Brain metastases (BM) represent a major health problem in patients with cancer. It is estimated that approximately 20–40% of patients with malignant neoplasia will develop brain metastasis during their disease. These lesions, whose incidence is increasing due to the improvement of primary cancers management, represent the most frequent intra-axial brain tumors.
Whole-brain radiation therapy (WBRT) has been for a while the standard treatment of BM. However, the advent of modern imaging techniques (CT and MRI), the improvement of surgical techniques and neuroanesthesia, and the positive impact of stereotactic radiotherapy (SRT) [radiosurgery, hypofractionated stereotactic radiotherapy (HSRT)], led to a reappraisal of local treatment modalities in BM management. Therapeutic decision depends on several factors related to tumor characteristics (number, radiological aspect, size, location), patient clinical status (neurological deficit, general condition, comorbidities, performance status) and primary disease status (controlled or uncontrolled, extracranial active metastatic disease).
In this article, we will present an overview of local treatment modalities in BM namely surgical and SRT indication. Respective toxicity of each approach will also be discussed.
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