Brain metastases

Despite advances in the treatment of cancer, brain metastases appear to be increasing in frequency and are associated with a poor prognosis. Type of tumor, age, performance status, and extent of systemic disease are important prognostic factors that should be taken into consideration when making treatment decisions. Patients with a good performance status and controlled systemic disease may benefit from aggressive focal therapies (surgery or radiosurgery). Whole brain radiotherapy seems to increase local control but is associated with the risk of delayed cognitive deterioration in long-term survivors. In spite of this, whole brain radiotherapy remains the standard of care for those patients with poorer prognosis and for the treatment of recurrence after focal therapy. Chemotherapy has a limited role in the treatment of brain metastases but should be considered in selected patient populations.