Intracerebral metastases medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Medical Therapy

The treatment options for intracerebral metastases include the following:[1]


 
 
 
 
 
 
 
 
Treatment for brain metatases
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Symptomatic treatment
 
 
 
 
 
 
 
 
 
Definitive treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Corticosteroids
 
Anticonvulsants
 
Whole brain radiotherapy
 
Surgery
 
Stereotactic radiosurgery
 
Chemotherapy
 

Symptomatic Treatment

  • Corticosteroid therapy is essential for all patients with brain metastases, as it prevents the development of cerebral edema, as well as treating other neurological symptoms such as headaches, cognitive dysfunction, and emesis. Dexamethasone is the corticosteroid of choice.[2][3]
  • Anticonvulsants should be used in patients with brain metastases who experience seizures, as there is a risk of status epilepticus and death. Phenytoin is the most commonly used drug, but valproic acid and other anticonvulsants can also be used. Newer anticonvulsants have the advantage of fewer toxic side effects.[3][4]
  • Hyperosmolar agents (i.e., mannitol) can be given to reduce intracranial pressure.[4]
  • Recently, methylphenidate and donepezil have been used to improve cognition, mood, and quality of life.

Radiation Therapy

  • Control the growth of the tumor(s)
  • Control neurological symptoms, such as headaches or seizures
  • Multiple brain metastases
  • More than 3 metastatic brain tumors or in people with poor performance status
  • Single brain metastasis that cannot be removed by surgery
  • Brain tumors are in an inaccesible area or if the affected area would be damaged by surgery
  • Post surgical removal of a single brain metastasis
  • To destroy remnant cancer cells post surgery and reduce the chance of recurrence

Chemotherapy

  • Chemotherapy is the use of cytotoxic drugs that circulate throughout the body and destroy cancer cells.[6]
  • Chemotherapy can help shrink brain metastases and improve symptoms in some cases.
  • Responsiveness of brain metastases to chemotherapy depends on how sensitive the primary cancer is to chemotherapy drugs (chemosensitivity).
  • Some types of cancer respond better or are more sensitive to chemotherapy than others. For example, chemotherapy may be used to treat lung cancer, breast cancer, or melanoma that has spread to the brain.
  • The chemotherapy drugs used depend on the type of primary tumor. The drugs, dose, and schedule will vary for each individual.

Gallery


References

  1. Andrew B. Lassman & Lisa M. DeAngelis (2003). "Brain metastases". Neurologic clinics. 21 (1): 1–23. PMID 12690643. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 Khuntia, Deepak (2015). "Contemporary Review of the Management of Brain Metastasis with Radiation". Advances in Neuroscience. 2015: 1–13. doi:10.1155/2015/372856. ISSN 2356-6787.
  3. 3.0 3.1 Symptomatic treatment of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 10, 2015
  4. 4.0 4.1 Symptomatic treatment of brain metastases. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 9, 2015
  5. 5.0 5.1 Radiation therapy for intracerebral metastases. Canadian cancer institute 2015. http://www.cancer.ca/en/cancer-information/cancer-type/metastatic-cancer/brain-metastases/treatment/?region=on. Accessed on November 13, 2015
  6. Chemotherapy for intracerebral metastases. Canadian cancer institute 2015. http://www.cancer.ca/en/cancer-information/cancer-type/metastatic-cancer/brain-metastases/treatment/?region=on. Accessed on November 13, 2015


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