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KMID : 1188520080040010004
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Korean Journal of Clinical Oncology
2008 Volume.4 No. 1 p.4 ~ p.9
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Metastatic Brain tumors
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Chung Dong-Sup
Hong Yong-Kil
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Abstract
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The incidence of brain metastasis is increasing because of longer survival of cancer patients as a result of the increase in early diagnosis of primary cancers, aggressive and advanced management, and improvements in imaging quality and accessibility. Contrast-enhanced MRI is now the gold standard for the diagnosis. Good prognostic factors for metastatic brain tumor are a high performance status, a solitary metastasis, an absence of systemic metastases, a controlled primary tumor and young age. The goal of treatment is to palliate local symptoms and prevent consequences of neurological involvement. Management consists of generalized supportive care and tumor directed treatment. Surgical resection is considered the treatment of choice for solitary brain metastasis. Whole brain radiation therapy (WBRT) remains standard treatment for all patients with brain metastases. The combination of surgery and WBRT is superior to WBRT alone. Radiosurgery offers the potential of treating patients with surgically inaccessible metastases. WBRT in conjunction with surgery or radiosurgery improves local control and reduces the risk of tumor relapse, but does not improve the overall survival. Therefore, there is an increasing tendency to omit adjuvant WBRT for reserving salvage treatment at recurrence. Although the role of chemotherapy for brain metastases still remains controversial, a new generation drugs like temozolomide and topotecan have antitumor activity against the brain metastases as well as the primary tumors. New radiosensitizers, cytotoxic or biologic agents and techniques of drug delivery are being investigated..
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KEYWORD
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Brain metastases, Surgery, Radiosurgery, Whole brain radiation therapy, Chemotherapy
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