Multidisciplinary Management of Brain Metastases

Learning Objectives After completing this course, the reader will be able to: Identify the clinical factors that predict survival after a diagnosis of brain metastasis. Select appropriate multidisciplinary treatments for patients with new and recurrent brain metastases. Describe the circumstances in which focal therapy, such as surgery or stereotactic radiosurgery, is likely to be beneficial for patients with brain metastases. Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com Metastatic brain tumors are the most common intracranial neoplasms in adults. The incidence of brain metastases appears to be rising as a result of superior imaging modalities, earlier detection, and more effective treatment of systemic disease. Therapeutic approaches to brain metastases include surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and chemotherapy. Treatment decisions must take into account clinical prognostic factors in order to maximize survival and neurologic function whilst avoiding unnecessary treatments. The goal of this article is to review important prognostic factors that may guide treatment selection, discuss the roles of surgery, radiation, and chemotherapy in the treatment of patients with brain metastases, and present new directions in brain metastasis therapy under active investigation. In the future, patients will benefit from a multidisciplinary approach focused on the integration of surgical, radiation, and chemotherapeutic options with the goal of prolonging survival, preserving neurologic and neurocognitive function, and maximizing quality of life. Disclosure of potential conflicts of interest is found at the end of this article.