Brain metastases: a medical neuro-oncology perspective

Brain metastases (BMs) are the most common neurological complication related to cancer. A review of recent and relevant literature relating to BMs was performed and found that the therapy of BMs remains controversial, notwithstanding numerous randomized clinical trials. Surgical resection of a solitary BM when possible, followed by whole-brain irradiation (WBI) is an established standard of care. More controversial is the substitution of stereotactic radiosurgery for surgery in the treatment of solitary BM. Treatment with WBI following local therapy remains controversial, with advocates for and against WBI. At present, systemic chemotherapy for BMs offers only very modest palliation. In summary, treatment of BMs remains contentious with respect to the utilization and timing of surgical resection, application of WBI and stereotactic radiosurgery, notwithstanding numerous randomized trials, as the range of interpretation of these trials has resulted in differing treatment perspectives.