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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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.[4]
- Recently, methylphenidate and donepezil have been used to improve cognition, mood, and quality of life.
Radiation Therapy
- The most widely used treatment for patients with multiple brain metastases is whole brain external beam radiotherapy (WBRT).[2]
- The role of radiation therapy in treatment of intracerebral metastases include:[5]
- Whole brain radiation therapy (WBRT) is a type of external beam radiation therapy. Indications for WBRT include:[5]
- Multiple brain metastases
- More than 3 metastatic brain tumors or in people with poor performance status
- Single brain metastasis that cannot be removed by surgery
- Brain tumors are in an inaccesible area or if the affected area would be damaged by surgery
- Post surgical removal of a single brain metastasis
- To destroy remnant cancer cells post surgery and reduce the chance of recurrence
Chemotherapy
- Chemotherapy is the use of cytotoxic drugs that circulate throughout the body and destroy cancer cells.[6]
- Chemotherapy can help shrink brain metastases and improve symptoms in some cases.
- Responsiveness of brain metastases to chemotherapy depends on how sensitive the primary cancer is to chemotherapy drugs (chemosensitivity).
- Some types of cancer respond better or are more sensitive to chemotherapy than others. For example, chemotherapy may be used to treat lung cancer, breast cancer, or melanoma that has spread to the brain.
- The chemotherapy drugs used depend on the type of primary tumor. The drugs, dose, and schedule will vary for each individual.
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
- ↑ 4.0 4.1 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
- ↑ 5.0 5.1 Radiation therapy for intracerebral metastases. Canadian cancer institute 2015. http://www.cancer.ca/en/cancer-information/cancer-type/metastatic-cancer/brain-metastases/treatment/?region=on. Accessed on November 13, 2015
- ↑ Chemotherapy for intracerebral metastases. Canadian cancer institute 2015. http://www.cancer.ca/en/cancer-information/cancer-type/metastatic-cancer/brain-metastases/treatment/?region=on. Accessed on November 13, 2015