Related Experiment Video
Updated: Mar 18, 2026
Modeling Brain Metastasis by Internal Carotid Artery Injection of Cancer Cells
Published on: August 2, 2022
Updates in the management of brain metastases
Nils D Arvold1, Eudocia Q Lee1, Minesh P Mehta1
1St. Luke's Radiation Oncology Associates, St. Luke's Cancer Center, Whiteside Institute for Clinical Research and University of Minnesota Duluth, Duluth, Minnesota (N.D.A.); Center for Neuro-Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (E.Q.L., P.Y.W.); Harvard Medical School, Boston, Massachusetts (E.Q.L., B.M.A., N.U.L., I.F.D., P.Y.W.); Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland (M.P.M.); Department of Medical Oncology, City of Hope, Duarte, California (K.M.); Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts (B.M.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (N.U.L.); Department of Medicine, Division of Hematology-Oncology, University of North Carolina, Chapel Hill, North Carolina (C.K.A.); Department of Neurology/Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Division of Medical Oncology, University of Colorado Denver, Denver, Colorado (D.R.C.); Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Neurosurgery, Brigham & Women's Hospital, Boston, Massachusetts (I.F.D.).
Abstract:
The clinical management/understanding of brain metastases (BM) has changed substantially in the last 5 years, with key advances and clinical trials highlighted in this review. Several of these changes stem from improvements in systemic therapy, which have led to better systemic control and longer overall patient survival, associated with increased time at risk for developing BM. Development of systemic therapies capable of preventing BM and controlling both intracranial and extracranial disease once BM are diagnosed is paramount. The increase in use of stereotactic radiosurgery alone for many patients with multiple BM is an outgrowth of the desire to employ treatments focused on local control while minimizing cognitive effects associated with whole brain radiotherapy. Complications from BM and their treatment must be considered in comprehensive patient management, especially with greater awareness that the majority of patients do not die from their BM. Being aware of significant heterogeneity in prognosis and therapeutic options for patients with BM is crucial for appropriate management, with greater attention to developing individual patient treatment plans based on predicted outcomes; in this context, recent prognostic models of survival have been extensively revised to incorporate molecular markers unique to different primary cancers.
Insights
Clinical management of brain metastases has advanced with improved systemic therapies and stereotactic radiosurgery. Personalized treatment plans incorporating molecular markers are crucial for better patient outcomes.
Area of Science:
- Neuro-oncology
- Cancer Metastasis
- Clinical Trials
Background:
- Brain metastases (BM) management has evolved significantly in recent years.
- Advances in systemic therapy have improved patient survival and control of extracranial disease.
- Increased survival leads to greater time at risk for developing BM.
Purpose of the Study:
- To review key advances and clinical trials in the management of brain metastases.
- To highlight the impact of systemic therapy improvements on BM.
- To discuss the role of stereotactic radiosurgery and personalized prognostic models.
Main Methods:
- Review of recent clinical trials and literature on brain metastases.
- Analysis of systemic therapy advancements.
- Evaluation of evolving treatment modalities like stereotactic radiosurgery.
- Assessment of updated prognostic models incorporating molecular markers.
Main Results:
- Systemic therapies have improved overall survival and systemic control, increasing the incidence of BM.
- Stereotactic radiosurgery is increasingly used for multiple BM, balancing local control and cognitive preservation.
- Majority of patients do not die from BM; complications and comprehensive management are key.
- Prognostic models are revised to include molecular markers for personalized treatment planning.
Conclusions:
- Effective systemic therapies are paramount for preventing and treating brain metastases.
- Personalized treatment strategies considering prognosis and molecular markers are essential for optimal patient management.
- Understanding the heterogeneity of BM and patient outcomes is critical for clinical decision-making.
