Guidelines for the Initial Management of Metastatic Brain Tumors: Role of Surgery, Radiosurgery, and Radiation Therapy

Authors:
Matthew G. Ewend From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.
From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.

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David E. Morris From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.
From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.

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Lisa A. Carey From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.
From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.

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Alim M. Ladha From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.

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Steven Brem From the Division of Neurosurgery, Lineberger Comprehensive Cancer Center, Department of Radiation Oncology, and Divison of Medical Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, and the Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida.

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Volume/Issue:
Volume 6: Issue 5
Online Publication Date:
May 2008
DOI:
https://doi.org/10.6004/jnccn.2008.0038
Full access

Brain metastases are an increasingly important determinant of survival and quality of life in patients with cancer. Current approaches to the management of brain metastases are driven by prognostic factors, including the Karnofsky Performance Status, tumor histology, number of metastases, patient age, and status of systemic disease. Most brain metastases are treated with radiosurgery, computer-assisted surgery, or whole brain radiation therapy. Remarkable advances in computer-assisted neuronavigation have made neurosurgical removal of metastases safer, even in eloquent areas of the brain. Computerization also enhances the efficacy and safety of conformal radiosurgery planning using various modern stereotactic radiosurgery (SRS) technologies, including newer frameless-based systems. Controversial issues include whether to defer whole brain radiotherapy (WBRT) in patients undergoing SRS or image-guided surgery and when to use SRS “boost” in a patient undergoing WBRT. The determination of how best to apply these treatments for individual patients cannot be standardized to a single paradigm, but data from well-controlled studies help physicians make informed decisions about the benefits and risks of each approach.

Correspondence: Matthew G. Ewend, MD, Division of Neurological Surgery, Burnett-Womack 3013, University of North Carolina, Chapel Hill, NC 27599. E-mail: ewend@med.unc.edu

EDITORS

Steven Brem, MD, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida

Disclosure: Steven Brem, MD, has disclosed that he has been involved in a research study with MGI.

CME AUTHOR

Désirée Lie, MD, MSEd, Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California

Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

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Copyright:
Copyright © 2008 by the National Comprehensive Cancer Network
Page Numbers:
10
Article Category:
Research Article
Received:
04 Feb 2008
Accepted:
19 Mar 2008
Print Publication Date:
01 May 2008
Online Publication Date:
May 2008
Keywords:
Brain metastasis; radiosurgery; radiation therapy; surgical therapy
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