Intracerebral metastases medical therapy

Intracerebral metastases Microchapters
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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]

Medical Therapy

The treatment options for intracerebral metastases include the following:

Treatment for brain metatases

Symptomatic treatment

Definitive treatment

Corticosteroids

Anticonvulsants

Whole brain radiotherapy

Surgery

Stereotactic radiosurgery

Chemotherapy

Symptomatic Treatment

• Corticosteroids are given to limit the effects of peritumoral edema.
• Hyperosmolar agents (i.e., mannitol) can be given to reduce intracranial pressure.
• Anticonvulsants are given to prevent seizures.
• 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).
• 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 neurological 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

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  _{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.).}

References

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