[Treatment of brain metastases]

The treatment of metastastic disease to the brain requires integration of neurosurgical, radiotherapeutic and oncological principles. Surgical resection is mandatory if a brain tumor manifests as an apparently unifocal lesion of a newly discovered neoplastic disorder. Furthermore, surgery is to be selected to alleviate signs and symptoms of increased intracranial pressure which can be caused by a mass effect and/or by obstruction of the CSF pathways. With regard to local tumor control of a single brain metastasis, resection followed by whole brain irradiation has proven superior to radiotherapy alone. Alternatively, a brain metastasis with a diameter of less than 3 cm can also be treated with Gamma-knife radio-surgery, a therapeutic modality that has also proven valuable in the control of multiple brain metastases and for local control following resection. Sometimes, local control can also be improved with a boost of conventional external beam radiotherapy onto a pre-irradiated site. Multiple brain metastases with lesions displaying a diameter of more than 3 cm not well suited for resection can also be treated with whole brain radiotherapy. Occasionally, a chemoresponsive tumor can be controlled with cytotoxic drugs. In conclusion, a carefully tailored therapeutic strategy can be very rewarding for both the patient and the specialists involved that definitively improves the quality of life by extending progression-free survival.