[Cerebral metastatis. Diagnostic and therapeutic features]

Brain metastases represent the most frequent intracranial neoplasms in adults: between 15 and 25% of patients with systemic tumors will face brain metastases along the clinical course of disease. Lung cancers, breast cancers and melanomas are the commonest causes of brain metastases (about 75%), while the primary site remains unknown inasmuch as 15% of cases. Headache, focal neurological deficits, epilepsy and intracranial hypertension are the most frequent initial symptoms and signs. Computerized Tomography and Magnetic Resonance represent the methods of choice for diagnosis. Supportive care is based on corticosteroids and antiepileptic drugs. Anticancer therapy planning must be based on prognostic factors: performance status, tumor activity and age. Surgical removal followed by external adjuvant radiotherapy is considered the best treatment in patients with single brain metastases and systemic disease under control or absent. Stereotactic radiosurgery is preferable in cases of unoperable metastatic lesions of the brain or progressive systemic disease. The usefulness of whole brain radiotherapy following surgery or radiosurgery is debated. In patients with multiple brain metastases, apart from radiotherapy, surgical excision of the symptomatic lesions, when feasible, seems advantageous. Chemotherapy is a valid option only in cases of metastases from chemosensitive neoplasms (small-cell lung tumors or breast tumors).