[Diagnosis and treatment for brain and spinal metastases]

Brain and spinal metastases are common complications of cancer and have the major impact on the prognosis of those patients. Survival time of such patients is still less than one year. Surgery with whole-brain radiation therapy (WBRT)has been used in the treatment of single-brain metastasis with a diameter of more than 3 cm. Stereotactic radiosurgery(SRS)including gamma knife is widely used for treatment for small and multiple brain metastases, however, recent clinical studies revealed that SRS+WBRT is superior to WBRT or SRS alone in survival time and local tumor control rates. Radiotherapy(RT)has also been a standard therapy for metastatic spinal cord compression and intramedullary metastasis, but recent studies revealed the effectiveness of surgery+RT for spinal metastasis. To improve QOL and survival of patients with brain and spinal metastasis, optimum and immediate management based on evidence- based medicine(EBM)is necessary.