Brain Metastases

Most tumors arising outside the nervous system can travel to the brain. The treatment of brain metastases depends on the type of tumor, number of tumors, and the amount of systemic disease. Initial treatment can consist of:

Surgery with whole brain radiation therapy. For single tumors, this has been proven to be the most effective way of treatment. Patients with more than one accessible tumor are also considered candidates for tumor resection. In addition, in the appropriate circumstance one symptomatic tumor may be removed while others may be treated with radiation therapy alone or with a radiosurgical boost.

Whole brain radiation therapy with a radiosurgical boost. This is appropriate for patients with up to four tumors that can be safely treated by this technique.

Whole brain radiation alone. This is indicated in patients with multiple (more than 4) brain metastases, those who cannot undergo surgical resection or a radiosurgical boost, or for those in whom surgery or radiosurgery is unsafe.

For some types of tumors, usually those sensitive to chemotherapy such as lymphoma, chemotherapy may be an alternative to radiation therapy.

Adjuncts to whole brain radiation therapy, such as RSR-13, an oxygen carrying compound, are currently in clinical trials.

Treatment of recurrent brain metastases can consist of:

Surgery.

Radiosurgical boost.

Whole brain radiation alone. This is indicated in patients with multiple (more than 4) brain metastases, those who cannot undergo surgical resection or a radiosurgical boost, or for those in whom surgery or radiosurgery is unsafe.

Chemotherapy.

An ongoing clinical trial is investigating the use of Thalidomide in the treatment of recurrent brain metastases.

	Radiation therapy	Chemotherapy
	Radiosurgery	Neoplastic Meningitis
	Clinical Trials	Thalidomide

	Surgery with whole brain radiation therapy. For single tumors, this has been proven to be the most effective way of treatment. Patients with more than one accessible tumor are also considered candidates for tumor resection. In addition, in the appropriate circumstance one symptomatic tumor may be removed while others may be treated with radiation therapy alone or with a radiosurgical boost.
	Whole brain radiation therapy with a radiosurgical boost. This is appropriate for patients with up to four tumors that can be safely treated by this technique.
	Whole brain radiation alone. This is indicated in patients with multiple (more than 4) brain metastases, those who cannot undergo surgical resection or a radiosurgical boost, or for those in whom surgery or radiosurgery is unsafe.
	For some types of tumors, usually those sensitive to chemotherapy such as lymphoma, chemotherapy may be an alternative to radiation therapy.
	Adjuncts to whole brain radiation therapy, such as RSR-13, an oxygen carrying compound, are currently in clinical trials.

	Surgery.
	Radiosurgical boost.
	Whole brain radiation alone. This is indicated in patients with multiple (more than 4) brain metastases, those who cannot undergo surgical resection or a radiosurgical boost, or for those in whom surgery or radiosurgery is unsafe.
	Chemotherapy.
	An ongoing clinical trial is investigating the use of Thalidomide in the treatment of recurrent brain metastases.