Intracerebral metastases medical therapy

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Intracerebral metastases Microchapters

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Pathophysiology

Causes

Differentiating Intracerebral Metastases from other Diseases

Epidemiology and Demographics

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Screening

Natural History, Complications and Prognosis

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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

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

  • Corticosteroids are given to limit the effects of peritumoral edema.[2]
  • Hyperosmolar agents (i.e., mannitol) can be given to reduce intracranial pressure.
  • Anticonvulsants are given to prevent seizures.[3]
  • 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).[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.

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References

  1. Andrew B. Lassman & Lisa M. DeAngelis (2003). "Brain metastases". Neurologic clinics. 21 (1): 1–23. PMID 12690643. Unknown parameter |month= ignored (help)
  2. 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. 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


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