Intracerebral metastases medical therapy: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 7: | Line 7: | ||
==Medical Therapy== | ==Medical Therapy== | ||
===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> | ||
| Line 20: | Line 19: | ||
*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. | *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. | *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. | ||
==Gallery== | |||
<gallery> | |||
Image:Whole brain external beam radiotherapy 1.PNG|<sub>Hippocampal sparing whole brain radiotherapy plan showing treatment of the whole brain to 30 Gy while sparing the hippocampi from high doses of radiation which is receiving less than 10 Gy mean dose. Furthermore, it is also possible to dose escalate the gross disease simultaneously (courtesy of Wolfgang Tomé, Ph.D.).<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></sub> | |||
</gallery> | |||
==References== | ==References== | ||
Revision as of 22:11, 9 November 2015
|
Intracerebral metastases Microchapters |
|
Differentiating Intracerebral Metastases from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Intracerebral metastases medical therapy On the Web |
|
American Roentgen Ray Society Images of Intracerebral metastases medical therapy |
|
Risk calculators and risk factors for Intracerebral metastases medical therapy |
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.
Gallery
-
![Hippocampal sparing whole brain radiotherapy plan showing treatment of the whole brain to 30 Gy while sparing the hippocampi from high doses of radiation which is receiving less than 10 Gy mean dose. Furthermore, it is also possible to dose escalate the gross disease simultaneously (courtesy of Wolfgang Tomé, Ph.D.).[1]](/images/3/3a/Whole_brain_external_beam_radiotherapy_1.PNG)
Hippocampal sparing whole brain radiotherapy plan showing treatment of the whole brain to 30 Gy while sparing the hippocampi from high doses of radiation which is receiving less than 10 Gy mean dose. Furthermore, it is also possible to dose escalate the gross disease simultaneously (courtesy of Wolfgang Tomé, Ph.D.).[1]
![Hippocampal sparing whole brain radiotherapy plan showing treatment of the whole brain to 30 Gy while sparing the hippocampi from high doses of radiation which is receiving less than 10 Gy mean dose. Furthermore, it is also possible to dose escalate the gross disease simultaneously (courtesy of Wolfgang Tomé, Ph.D.).[1]](/index.php/File:Whole_brain_external_beam_radiotherapy_1.PNG)
References
- ↑ 1.0 1.1 1.2 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.
- ↑ 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