Intracerebral metastases medical therapy: Difference between revisions
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===Symptomatic Treatment=== | ===Symptomatic Treatment=== | ||
*Corticosteroids are given to limit the effects of peritumoral edema.<ref name="Khuntia2015">{{cite journal|last1=Khuntia|first1=Deepak|title=Contemporary Review of the Management of Brain Metastasis with Radiation|journal=Advances in Neuroscience|volume=2015|year=2015|pages=1–13|issn=2356-6787|doi=10.1155/2015/372856}}</ref> | *Corticosteroids are given to limit the effects of peritumoral edema.<ref name="Khuntia2015">{{cite journal|last1=Khuntia|first1=Deepak|title=Contemporary Review of the Management of Brain Metastasis with Radiation|journal=Advances in Neuroscience|volume=2015|year=2015|pages=1–13|issn=2356-6787|doi=10.1155/2015/372856}}</ref> | ||
*Hyperosmolar agents (i.e., [[mannitol]]) can be given to reduce intracranial pressure | *Hyperosmolar agents (i.e., [[mannitol]]) can be given to reduce intracranial pressure. | ||
*[[Anticonvulsants]] are given to prevent [[seizures]]. | *[[Anticonvulsants]] are given to prevent [[seizures]].<ref name=symptomaticrxofbrainmetastasis1>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</ref> | ||
*Recently, [[methylphenidate]] and [[donepezil]] have been used to improve cognition, mood, and quality of life. | *Recently, [[methylphenidate]] and [[donepezil]] have been used to improve cognition, mood, and quality of life. | ||
Revision as of 21:59, 9 November 2015
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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
Symptomatic Treatment
- Corticosteroids are given to limit the effects of peritumoral edema.[1]
- Hyperosmolar agents (i.e., mannitol) can be given to reduce intracranial pressure.
- Anticonvulsants are given to prevent seizures.[2]
- Recently, methylphenidate and donepezil have been used to improve cognition, mood, and quality of life.
Therapeutic
Radiation Therapy
- The most widely used treatment for patients with multiple brain metastases is whole brain external beam radiotherapy (WBRT).[1]
- Stereotactic radiosurgery is done for smaller masses.
- The appropriate use of WBRT can provide rapid improvements of many neurologic symptoms, improve quality of life, and may be especially beneficial in patients whose brain metastases are surgically inaccessible or when other medical considerations remove surgery from the list of appropriate options [32–34]. The use of adjuvant WBRT, following resection or radiosurgery has been proven to be effective in terms of improving local control of brain metastases, and, furthermore, the likelihood of neurologic death is decreased based on a randomized trial.
- In patients who have brain metastases that impinge upon eloquent areas or are too large, numerous, disseminated for surgery or radiosurgery, or in patients that performance status does not allow for more aggressive therapy, whole brain external beam radiotherapy alone remains the treatment of choice and provides effective symptom relief. Response rates following whole brain external beam radiotherapy vary with complete or partial responses in more than 60% of patients.
References
- ↑ 1.0 1.1 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.
- ↑ 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