Brain metastases: current management and new developments.

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Neurosurgery

Background:

• Brain metastases represent a significant challenge in oncology.
• Optimal management requires balancing survival, neurologic function, and treatment-related toxicities.

Purpose of the Study:

• To review current management strategies for brain metastases.
• To highlight recent advancements and future directions in the field.

Main Methods:

• Review of current literature on brain metastases management.
• Analysis of treatment decisions based on prognostic factors.
• Evaluation of radiotherapy, surgery, and systemic therapy roles.

Main Results:

• Whole-brain radiotherapy (WBRT) is standard for unfavorable prognosis; stereotactic radiosurgery (SRS) or surgery for favorable prognosis and limited disease.
• Combining SRS/surgery with WBRT improves survival in single brain metastasis.
• Omitting WBRT after SRS/surgery impacts local control but not survival; neurocognitive deficits post-WBRT require further study.
• Chemotherapy has a limited role, while molecularly targeted therapies are increasingly utilized; WBRT prophylaxis is standard for small-cell lung cancer.

Conclusions:

• Future trials should investigate radiosensitizers, post-surgical local treatments, and targeted therapies based on molecular profiles.
• Quality of life and cognitive function are critical endpoints for clinical trials in brain metastases management.