Brain metastases continue to be a major and growing challenge in oncology, but recent advances in surgery, radiosurgery, and
chemotherapy have broadened the number of treatment options. Current approaches to the management of
brain metastases focus on individualizing patient care based on factors including the Karnofsky Performance Status, the
tumor histology, the number of
metastases, and the status of the systemic disease. A number of treatment approaches have been shown to be effective for
brain metastases, including surgery; radiosurgery; whole-brain
radiotherapy; and, more recently,
chemotherapy. The use of adjuvant whole-brain
radiotherapy with local
therapies, such as surgery or radiosurgery, along with newer
chemotherapy options, such as targeted biological agents,
temozolomide, and implantable
1,3-bis(2-chloroethyl)-1-nitrosourea (
BCNU)
Gliadel wafers, are at the forefront of recent advances in the treatment of patients with
brain metastases that may provide longer survival and improved quality of life. Although there is no current standard treatment, some general guidelines are recommended for single
metastases, oligometastases (two to three
brain metastases), and multiple (four or more)
brain metastases, and for new or recurrent disease. With advances in systemic
therapy for
cancer, the treatment of
brain metastases is becoming an increasingly important determinant of the length of survival and quality of life for
cancer patients.