Treatment of brain metastases

Brain metastases are a common complication of cancer, found in approximately 20% of patients at autopsy. The diagnosis is usually established by neuroimaging and carries a poor overall prognosis. Supportive therapies, such as corticosteroids, anticonvulsants, and anticoagulants, are necessary for most patients to address the common medical complications that often accompany brain metastases. These treatments often ameliorate symptoms and signs and improve neurologic function, but they require careful management to minimize their common toxicities. Definitive antitumor treatment may include whole-brain radiotherapy, surgery, stereotactic radiosurgery, and chemotherapy. A multimodal approach can yield prolonged survival of a year or more in some patients, particularly those with limited intracranial disease, high performance status, limited systemic cancer burden, young age, and certain tumor pathologies. However, even patients with poor prognostic factors can have some relief of neurologic symptoms and signs with the institution of therapy. Patients with recurrent brain metastases can also benefit from additional treatment, including all the modalities available at diagnosis.