The incidence of
brain metastases has increased over time as a consequence of an increase in the overall survival of patients with various types of
cancer and the improved detection by magnetic resonance imaging (MRI). In this study, the guidelines and evidence for the radiotherapeutic, surgical, and chemotherapeutic management of patients newly diagnosed with
brain metastases have been reviewed. For patients with good prognosis (expected survival, ≥ 3 months) and single
brain metastases (> 3-4 cm) in whom safe complete resection is possible, whole brain
radiotherapy (WBRT) and surgery (level 1) should be considered. Another alternative is surgery and radiation boost to the resection cavity (level 3). For single
brain metastases (< 3-4 cm) that are not resectable, WBRT and radiosurgery, or radiosurgery alone should be considered (level 1). For selected patients with a limited number of multiple
brain metastases (all < 3-4 cm) and good prognosis (expected survival, ≥ 3 months), radiosurgery alone, WBRT and radiosurgery, or WBRT alone should be considered (level 1). However, data from recent clinical trials have shown that adjuvant WBRT after radiosurgery or surgery for a limited number of
brain metastases reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival. Many clinical studies have reported the effectiveness of
molecular targeted therapies for
brain metastases.
Gefitinib or
erlotinib should be considered for the treatment of asymptomatic patients harboring activating
epidermal growth factor receptor (EGFR) mutations.
Lapatinib should also be considered for the treatment of patients with
brain metastases from human
epidermal growth factor receptor (HER)-2-overexpressing metastatic
breast cancer. In Japan, the
intravenous administration of
bevacizumab is currently being used for the treatment of symptomatic radiation
necrosis of the brain.