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Neuro-Oncology

Multidisciplinary Management of Brain Metastases

^aPappas Center for Neuro-Oncology, Departments of ^bNeurology and ^cRadiation Oncology, Massachusetts General Hospital and ^dHarvard Medical School, Boston, Massachusetts, USA

Key Words. Neoplasm metastasis • Brain neoplasms • Therapeutics • Ionizing radiation • Drug therapy

Correspondence: April F. Eichler, M.D., Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, Massachusetts 02114, USA. Telephone: 617-724-1548; Fax: 617-724-8769; e-mail: aeichler{at}partners.org

Metastatic brain tumors are the most common intracranial neoplasms in adults. The incidence of brain metastases appears to be rising as a result of superior imaging modalities, earlier detection, and more effective treatment of systemic disease. Therapeutic approaches to brain metastases include surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and chemotherapy. Treatment decisions must take into account clinical prognostic factors in order to maximize survival and neurologic function whilst avoiding unnecessary treatments. The goal of this article is to review important prognostic factors that may guide treatment selection, discuss the roles of surgery, radiation, and chemotherapy in the treatment of patients with brain metastases, and present new directions in brain metastasis therapy under active investigation. In the future, patients will benefit from a multidisciplinary approach focused on the integration of surgical, radiation, and chemotherapeutic options with the goal of prolonging survival, preserving neurologic and neurocognitive function, and maximizing quality of life.

Disclosure of potential conflicts of interest is found at the end of this article.

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