Considerations in the diagnosis and management of brain metastases

Brain metastases are a common complication of systemic cancer and a significant cause of morbidity. For patients whose brain metastases remain untreated, the prognosis is poor. The advent of contrast-enhanced magnetic resonance imaging has made accurate diagnosis of brain metastases among symptomatic patients a much more manageable task. However, approximately one-third of patients with intracranial metastases are asymptomatic, and therefore, greater awareness of the risk factors for developing brain metastases may permit better targeting of "at risk" patients for further evaluation. Advances in technology and surgical techniques have created more options for the management of brain metastases via the use of various combinations of surgery, irradiation, and stereotactic radiosurgery. However, successful application of these therapies has redefined the potential for long-term morbidity associated with radiation therapy. Thus, considerable effort is now being directed toward finding a balance between the use of whole-brain radiotherapy, surgery, and radiosurgery, and tailoring those treatment modalities to the unique needs of the patient. Although more prospective, randomized studies are needed before an informed consensus regarding the optimal means for managing brain metastases can be established, this article provides an overview of some of the advantages and disadvantages of therapeutic approaches recently under study.