Intracerebral metastases medical therapy
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Intracerebral metastases Microchapters |
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Differentiating Intracerebral Metastases from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Intracerebral metastases medical therapy On the Web |
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American Roentgen Ray Society Images of Intracerebral metastases medical therapy |
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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
The treatment options for intracerebral metastases include the following:[1]
Treatment for brain metatases | |||||||||||||||||||||||||||||||||||||||||||||||||
Symptomatic treatment | Definitive treatment | ||||||||||||||||||||||||||||||||||||||||||||||||
Corticosteroids | Anticonvulsants | Whole brain radiotherapy | Surgery | Stereotactic radiosurgery | Chemotherapy | ||||||||||||||||||||||||||||||||||||||||||||
Symptomatic Treatment
- Corticosteroid therapy is essential for all patients with brain metastases, as it prevents the development of cerebral edema, as well as treating other neurological symptoms such as headaches, cognitive dysfunction, and emesis. Dexamethasone is the corticosteroid of choice.[2][3]
- Anticonvulsants should be used in patients with brain metastases who experience seizures, as there is a risk of status epilepticus and death. Phenytoin is the most commonly used drug, but valproic acid and other anticonvulsants can also be used. Newer anticonvulsants have the advantage of fewer toxic side effects.[3][4]
- Hyperosmolar agents (i.e., mannitol) can be given to reduce intracranial pressure.
- Recently, methylphenidate and donepezil have been used to improve cognition, mood, and quality of life.
Therapeutic Treatment
Radiation Therapy
- The most widely used treatment for patients with multiple brain metastases is whole brain external beam radiotherapy (WBRT).[2]
- 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.).[2]](/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.).[2]
![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.).[2]](/index.php/File:Whole_brain_external_beam_radiotherapy_1.PNG)
References
- ↑ Andrew B. Lassman & Lisa M. DeAngelis (2003). "Brain metastases". Neurologic clinics. 21 (1): 1–23. PMID 12690643. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 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.
- ↑ 3.0 3.1 Symptomatic treatment of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 10, 2015
- ↑ 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