Materiały źródłowe

• #1 Brain Metastasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470246/

  Brain metastases are a common complication of cancer and the most common type of brain tumor. Anywhere from 10% to 26% of patients who die from their cancer will develop brain metastases. […] Primary cancers such as lung, breast, and melanoma are most likely to metastasize to the brain. Small-cell lung cancer has a high propensity to spread to the brain such that prophylactic treatment (cranial irradiation) is considered the standard of care. Other malignancies such as prostate and head and neck cancers rarely result in brain metastases. […] It can be difficult to predict which patients will develop brain metastases other than by using tumor type and subtype.

• #2 Brain metastases: an overview

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6093020/

  Brain metastases (BMs) are the most frequent cause of malignant tumor of the central nervous system (CNS), four-times higher than primary tumors; about 20-40% of patients with cancer will develop BM in their clinical course. […] Furthermore, the frequency of BM is increasing over the years as a result of the increase in overall survival (OS) in cancer patients and of the improvement in diagnostic tools for BM detecting, as magnetic resonance imaging (MRI). […] Primary tumors that most frequently metastasize to brain are in order of frequency: lung (50%), breast (15-25%), melanoma (5-20%) and, less frequently, testis, kidney, colon-rectum, thyroid, but more in general any cancer subtype can metastasize to the brain. […] In 15% of cases, the primary site is unknown. […] BMs usually develop in advanced stages of disease, less frequently BMs are the first clinical sign of cancer and/or synchronous with primary tumor diagnosis.

• #3 Management of Brain Metastases

  https://www.cancernetwork.com/view/management-brain-metastases

  Brain metastases are the most common type of brain tumor in adults and are an increasingly important cause of morbidity and mortality in cancer patients. […] Brain metastases are a common complication in cancer patients and an important cause of morbidity and mortality. They develop in approximately 10% to 30% of adults and 6% to 10% of children with cancer. […] In adults, the primary tumors most often responsible for brain metastases are lung cancer (50%), breast cancer (15% to 20%), unknown primary tumor (10% to 15%), melanoma (10%), and colon cancer (5%). […] The most common mechanism of metastasis to the brain is by hematogenous spread. […] The distribution of brain metastases roughly follows the relative weight of (and blood flow to) each area. […] The clinical features of brain metastases are extremely variable, and the presence of brain metastases should be suspected in any cancer patient who develops new neurologic symptoms.

• #4 Brain metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-metastases?lang=us

  Brain metastases are estimated to account for approximately 25-50% of intracranial tumors in hospitalized patients. […] The true incidence of brain metastases is unknown, but estimates are as high as 200,000 cases per year in the United States alone. […] Five primary tumors account for 80% of brain metastases: lung cancer, renal cell carcinoma, breast cancer, melanoma, and gastrointestinal tract adenocarcinomas (the majority are colorectal carcinoma). […] A population-based study of 169,444 cancer patients from 1973-2001 in Detroit revealed that overall, 10% of patients diagnosed with one of these five primaries went on to develop brain metastases. Specifically, 20% of lung cancers, 7% of melanomas, 7% of renal cancers, 5% of breast cancers and 2% of colorectal cancers metastasized to the brain. […] In patients with known malignancies, the brain can sometimes act as a reservoir for metastatic disease as traditional chemotherapy regimens can have poor permeability through the blood-brain barrier. This can lead to presentation with cerebral metastases, even with quiescent systemic disease.

• #5 Brain metastases – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/symptoms-causes/syc-20350136

  Brain metastases happen when cancer begins elsewhere in the body and spreads (metastasizes) to the brain. […] Brain metastases happen when cancer cells spread from their original site to the brain. Any cancer can spread to the brain. But the most common types that spread are lung, breast, colon, kidney and melanoma. […] Brain metastases occur when cancer cells break away from their original location. The cells may travel through the bloodstream or lymphatic system and spread to the brain. […] Cancer that spreads from its original location is known by the name of the primary cancer. For example, cancer that has spread from the breast to the brain is called metastatic breast cancer, not brain cancer. […] Any type of cancer can spread to the brain. Some of the types that are more likely to spread include lung cancer, breast cancer, colon cancer, kidney cancer, and melanoma.

• #6 What is secondary brain cancer? | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/secondary-cancer/secondary-brain-cancer/about

  Secondary brain cancer is when a cancer that started somewhere else in the body has spread to the brain. […] A secondary cancer is a cancer that has spread from where it first started to another part of the body. […] Secondary cancers happen when cancer cells break off the primary cancer and move through the body. This can happen by cancer cells passing through the blood or the lymphatic system. […] The cancer cells can travel through the blood and lymphatic systems to other parts of the body. […] Cancer can spread to anywhere in the body but there are places that it is more likely to spread to depending on where your cancer started. […] Any cancer can spread to the brain. […] Secondary brain cancer cant usually be cured.

• #7 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Brain-Metastases-Incidence-Symptoms-and-Causes.aspx

  Metastatic brain tumors are the most common type of brain tumor found in adults. These tumors arise as a result of cancer that has spread from another part of the body. […] Studies show that cancer cells break away from the primary tumor and enter the circulatory system or blood stream. The cells then use the circulatory system to migrate to other organs in the body. Initially, they move into the lungs and, from there, they migrate towards other organs such as the brain. Some research suggests these cancer cells can separate from the primary tumor even in the earliest stages of cancer. When these circulating cancer cells enter a new organ, they may lie dormant or rapidly divide and give rise to a secondary tumor. […] Depending on the type of primary cancer, the cells that break away will affect different organs first. For example, since the lungs send blood to the brain, lung cancer can spread quickly to the brain. Colon cancer tends to spread to the liver and lungs, while breast cancer eventually involves the bones, lungs and brain.

• #8 Brain Metastasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1157902-overview

  Breast tumor is the main source of metastatic disease in women, followed by melanoma, renal, and colorectal tumors. […] Melanoma commonly metastasizes to the brain. Melanoma has an increased incidence among other systemic cancers in terms of metastasizing to the brain. […] Cancer-cell trafficking may not be entirely random, and factors produced by stromal cells may guide their final destination in the brain. […] Different tumors metastasize preferentially to different organs. […] Recently, it has been shown that metastases may have originated from cancer initiating cells, which are more resistant to therapy by virtue of their stemlike properties. […] Cancer cells have been shown to recruit bone marrowderived cells to modify the microenvironment of distant recipient site; the formation of a premetastatic niche by alternating the level of fibronectin and making the site more favorable for the colonization of metastatic tumor.

• #9 Management of Brain Metastases

  https://www.cancernetwork.com/view/management-brain-metastases

  Brain metastases are the most common type of brain tumor in adults and are an increasingly important cause of morbidity and mortality in cancer patients. […] Brain metastases are a common complication in cancer patients and an important cause of morbidity and mortality. They develop in approximately 10% to 30% of adults and 6% to 10% of children with cancer. […] In adults, the primary tumors most often responsible for brain metastases are lung cancer (50%), breast cancer (15% to 20%), unknown primary tumor (10% to 15%), melanoma (10%), and colon cancer (5%). […] The most common mechanism of metastasis to the brain is by hematogenous spread. […] The distribution of brain metastases roughly follows the relative weight of (and blood flow to) each area. […] The clinical features of brain metastases are extremely variable, and the presence of brain metastases should be suspected in any cancer patient who develops new neurologic symptoms.

• #10 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Brain-Metastases-Incidence-Symptoms-and-Causes.aspx

  Metastatic brain tumors are the most common type of brain tumor found in adults. These tumors arise as a result of cancer that has spread from another part of the body. […] Studies show that cancer cells break away from the primary tumor and enter the circulatory system or blood stream. The cells then use the circulatory system to migrate to other organs in the body. Initially, they move into the lungs and, from there, they migrate towards other organs such as the brain. Some research suggests these cancer cells can separate from the primary tumor even in the earliest stages of cancer. When these circulating cancer cells enter a new organ, they may lie dormant or rapidly divide and give rise to a secondary tumor. […] Depending on the type of primary cancer, the cells that break away will affect different organs first. For example, since the lungs send blood to the brain, lung cancer can spread quickly to the brain. Colon cancer tends to spread to the liver and lungs, while breast cancer eventually involves the bones, lungs and brain.

• #11 What Causes Brain Metastases? – Brainlab.org

  https://www.brainlab.org/get-educated/brain-metastasis/investigate-brain-metastasis/what-causes-brain-metastases/

  Brain metastases are a common complication of primary cancers and a significant cause of morbidity and mortality the rates of disease and death in certain populations according to the American Association of Neurological Surgeons. These tumors do not start in the brain, but occur when cancer cells break away from a cancer in another area of the body and travel to the brain. […] In the case of metastatic brain tumors, the cancer cells travel and spread to the brain. This spreading of the primary cancer is known as metastasizing. For example, when lung cancer metastasizes to the brain, this brain cancer is actually made up of lung cancer cells. […] Among types of primary tumors, lung cancers are responsible for the highest number of brain metastases. Other cancers that commonly metastasize to the brain are melanoma (skin cancer) as well as breast, colon and kidney cancer, but any type of cancer could potentially spread to the brain.

• #12 Brain Metastasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1157902-overview

  Breast tumor is the main source of metastatic disease in women, followed by melanoma, renal, and colorectal tumors. […] Melanoma commonly metastasizes to the brain. Melanoma has an increased incidence among other systemic cancers in terms of metastasizing to the brain. […] Cancer-cell trafficking may not be entirely random, and factors produced by stromal cells may guide their final destination in the brain. […] Different tumors metastasize preferentially to different organs. […] Recently, it has been shown that metastases may have originated from cancer initiating cells, which are more resistant to therapy by virtue of their stemlike properties. […] Cancer cells have been shown to recruit bone marrowderived cells to modify the microenvironment of distant recipient site; the formation of a premetastatic niche by alternating the level of fibronectin and making the site more favorable for the colonization of metastatic tumor.

• #13 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Brain-Metastases-Incidence-Symptoms-and-Causes.aspx

  Metastatic brain tumors are the most common type of brain tumor found in adults. These tumors arise as a result of cancer that has spread from another part of the body. […] Studies show that cancer cells break away from the primary tumor and enter the circulatory system or blood stream. The cells then use the circulatory system to migrate to other organs in the body. Initially, they move into the lungs and, from there, they migrate towards other organs such as the brain. Some research suggests these cancer cells can separate from the primary tumor even in the earliest stages of cancer. When these circulating cancer cells enter a new organ, they may lie dormant or rapidly divide and give rise to a secondary tumor. […] Depending on the type of primary cancer, the cells that break away will affect different organs first. For example, since the lungs send blood to the brain, lung cancer can spread quickly to the brain. Colon cancer tends to spread to the liver and lungs, while breast cancer eventually involves the bones, lungs and brain.

• #14 Brain metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-metastases?lang=us

  Brain metastases are estimated to account for approximately 25-50% of intracranial tumors in hospitalized patients. […] The true incidence of brain metastases is unknown, but estimates are as high as 200,000 cases per year in the United States alone. […] Five primary tumors account for 80% of brain metastases: lung cancer, renal cell carcinoma, breast cancer, melanoma, and gastrointestinal tract adenocarcinomas (the majority are colorectal carcinoma). […] A population-based study of 169,444 cancer patients from 1973-2001 in Detroit revealed that overall, 10% of patients diagnosed with one of these five primaries went on to develop brain metastases. Specifically, 20% of lung cancers, 7% of melanomas, 7% of renal cancers, 5% of breast cancers and 2% of colorectal cancers metastasized to the brain. […] In patients with known malignancies, the brain can sometimes act as a reservoir for metastatic disease as traditional chemotherapy regimens can have poor permeability through the blood-brain barrier. This can lead to presentation with cerebral metastases, even with quiescent systemic disease.

• #15 Brain Metastasis from Lung Cancer | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/lung-cancer-staging/brain-metastasis

  Brain metastases (sometimes called brain mets) occur when cancer cells spread from their original site, in this case the lung, to the brain. […] It is common for cancer cells to break off from the original tumor and travel through the bloodstream to other organs. In the case of lung cancer, one of the organs it most commonly travels to is the brain. The risk of lung cancer spreading to the brain is highest in small cell lung cancer and some specific forms of lung cancer like EGFR mutant or ALK rearranged lung cancer. If you have stage four lung cancer, your risk of brain metastasis is higher. […] Generally, brain metastases in lung cancer patients are very common. It does vary by the type of lung cancer you have or the specific biomarkers found in the cancer cells. Among patients with lung cancer, about 16 to 20 percent develop brain metastases.

• #16 Brain Metastasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1157902-overview

  Brain metastases are cancer cells that have spread to the brain from primary tumors in other organs in the body. It is estimated that 20%40% of all patients diagnosed with a primary cancer will develop a secondary cancer in the brain. […] Brain metastases account for 20% of cancer deaths annually, a rate that can be traced to an increase in the median survival of patients with cancer because of modern therapies, increased availability of advanced imaging techniques for early detection, and vigilant surveillance protocols for monitoring recurrence. […] The most common origins of brain metastasis are systemic cancer of the lung, breast, skin, or GI tract. […] Primary lung tumors account for 50% of all metastatic brain tumors. Lung cancer is the most common origin of metastatic disease.

• #17 Brain Metastases: When Cancer Spreads to the Brain

  https://my.clevelandclinic.org/health/diseases/17225-metastatic-brain-tumors

  Metastatic brain tumors occur when cells from an existing tumor break off and spread to your brain. Usually, the cancer cells travel via your bloodstream. Researchers aren’t sure why some primary cancers are more likely to metastasize. […] The most common forms of brain metastases are: Lung cancer: About half of people with lung cancer develop metastatic brain cancer. Brain metastases are especially common with small cell lung cancer. Breast cancer: Approximately 10% to 15% of all people with metastatic breast cancer develop brain metastases. Metastatic brain tumors are more common in HER2+ breast cancer and triple-negative breast cancer. Melanoma: About half of people with melanoma develop brain metastases. […] Less often, brain metastases arise from kidney cancer, colon cancer and thyroid cancer, among others.

• #18 Brain Metastases | Living Beyond Breast Cancer

  https://www.lbbc.org/about-breast-cancer/types-breast-cancer/metastatic-breast-cancer/brain-metastases

  Brain metastases are areas of cancer that develop when breast cancer cells spread to the brain and form tumors. […] Right now, doctors don’t know exactly how breast cancer cells spread to the brain and begin to grow. The small blood vessels in the brain have a protective inner lining known as the blood-brain barrier, which keeps harmful toxins from getting into the brain. How breast cancer cells break through this barrier isn’t well understood. But it is the subject of ongoing research. Some researchers believe certain genetic pathways may help breast cancer cells cross through the blood-brain barrier to cause brain mets. […] While about 15-20 percent of women diagnosed with metastatic breast cancer are eventually diagnosed with brain metastasis, some have a higher risk of developing it than others. Doctors don’t know why, but breast cancer that is both HER2-positive and hormone receptor-negative, or triple-negative, is more likely to spread to the brain than hormone receptor-positive breast cancer.

• #19 Brain Metastases: When Cancer Spreads to the Brain

  https://my.clevelandclinic.org/health/diseases/17225-metastatic-brain-tumors

  Metastatic brain tumors occur when cells from an existing tumor break off and spread to your brain. Usually, the cancer cells travel via your bloodstream. Researchers aren’t sure why some primary cancers are more likely to metastasize. […] The most common forms of brain metastases are: Lung cancer: About half of people with lung cancer develop metastatic brain cancer. Brain metastases are especially common with small cell lung cancer. Breast cancer: Approximately 10% to 15% of all people with metastatic breast cancer develop brain metastases. Metastatic brain tumors are more common in HER2+ breast cancer and triple-negative breast cancer. Melanoma: About half of people with melanoma develop brain metastases. […] Less often, brain metastases arise from kidney cancer, colon cancer and thyroid cancer, among others.

• #20 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment. […] More than 60% of all Stage IV melanoma patients will develop brain metastases at some point, but certain factors increase the risk: The primary tumor was on the head, neck, trunk, or abdomen; The primary tumor was ulcerated, deep, or invasive; The LDH is elevated at diagnosis of unresectable Stage III or Stage IV; The presence of NRAS or BRAF mutation; The melanoma has spread to the internal organs. […] There are several potential reasons: There is growing evidence that brain tumors are very different from tumors in other parts of the body and may need to be treated differently; The brain looks familiar. Melanocytes arise from the same part of the early embryo as the brain, so the brain might be a very natural environment for melanoma tumors to grow in; Often, by the time a patient first exhibits symptoms, s/he already has multiple lesions, not just one; Brain metastases tend to be very aggressive and even a small increase in their size can cause more symptoms; The brain has many defenses to reduce the penetration of harmful substances. This system is called the blood-brain-barrier, and also it prevents many medications from entering the brain; Treatment options may damage surrounding normal tissue and have significant impact on the quality of life.

• #21 Brain metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-metastases?lang=us

  Brain metastases are estimated to account for approximately 25-50% of intracranial tumors in hospitalized patients. […] The true incidence of brain metastases is unknown, but estimates are as high as 200,000 cases per year in the United States alone. […] Five primary tumors account for 80% of brain metastases: lung cancer, renal cell carcinoma, breast cancer, melanoma, and gastrointestinal tract adenocarcinomas (the majority are colorectal carcinoma). […] A population-based study of 169,444 cancer patients from 1973-2001 in Detroit revealed that overall, 10% of patients diagnosed with one of these five primaries went on to develop brain metastases. Specifically, 20% of lung cancers, 7% of melanomas, 7% of renal cancers, 5% of breast cancers and 2% of colorectal cancers metastasized to the brain. […] In patients with known malignancies, the brain can sometimes act as a reservoir for metastatic disease as traditional chemotherapy regimens can have poor permeability through the blood-brain barrier. This can lead to presentation with cerebral metastases, even with quiescent systemic disease.

• #22 Management of Brain Metastases

  https://www.cancernetwork.com/view/management-brain-metastases

  Brain metastases are the most common type of brain tumor in adults and are an increasingly important cause of morbidity and mortality in cancer patients. […] Brain metastases are a common complication in cancer patients and an important cause of morbidity and mortality. They develop in approximately 10% to 30% of adults and 6% to 10% of children with cancer. […] In adults, the primary tumors most often responsible for brain metastases are lung cancer (50%), breast cancer (15% to 20%), unknown primary tumor (10% to 15%), melanoma (10%), and colon cancer (5%). […] The most common mechanism of metastasis to the brain is by hematogenous spread. […] The distribution of brain metastases roughly follows the relative weight of (and blood flow to) each area. […] The clinical features of brain metastases are extremely variable, and the presence of brain metastases should be suspected in any cancer patient who develops new neurologic symptoms.

• #23 Brain metastases: Literature review | Revista Médica del Hospital General de México

  https://www.elsevier.es/en-revista-revista-medica-del-hospital-general-325-articulo-brain-metastases-literature-review-S0185106316300166

  Brain metastases frequently occur secondary to poorly controlled primary lung, breast, melanoma, colorectal and renal tumours. […] The real incidence of metastatic brain tumours remains unknown, although some countries such as the United States of America report 17,000 cases annually, and some authors consider brain metastases such as intracranial tumour to be more common. […] Certain types of cancers are more prone to spread to the central nervous system. The most common, in order of frequency, are lung cancer, breast cancer, melanoma, colorectal and renal cancer, and less frequently thyroid cancer, gastrointestinal cancer and prostate cancer. […] The prognosis of brain metastasis patients in the last two decades with the use of combined therapies shows an increase in survival compared to patients who only received radiotherapy or surgery.

• #24 Brain metastases: an overview

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6093020/

  Brain metastases (BMs) are the most frequent cause of malignant tumor of the central nervous system (CNS), four-times higher than primary tumors; about 20-40% of patients with cancer will develop BM in their clinical course. […] Furthermore, the frequency of BM is increasing over the years as a result of the increase in overall survival (OS) in cancer patients and of the improvement in diagnostic tools for BM detecting, as magnetic resonance imaging (MRI). […] Primary tumors that most frequently metastasize to brain are in order of frequency: lung (50%), breast (15-25%), melanoma (5-20%) and, less frequently, testis, kidney, colon-rectum, thyroid, but more in general any cancer subtype can metastasize to the brain. […] In 15% of cases, the primary site is unknown. […] BMs usually develop in advanced stages of disease, less frequently BMs are the first clinical sign of cancer and/or synchronous with primary tumor diagnosis.

• #25 Brain Metastases | LifeBridge Health

  https://www.lifebridgehealth.org/conditions/brain-metastases

  A brain metastasis is a tumor that develops from cancer cells that have spread from other cancerous sites in the body to the brain, usually through the bloodstream. […] Although the most common sources of brain metastases in adults include lung, breast and skin (melanoma) cancers, the primary site or tissue origin of the metastases is unknown in up to 15 percent of patients. […] As a general rule, almost any systemic cancer is capable of metastasizing or spreading to the brain. […] Treatment with oral steroids (e.g., Decadron, dexamethasone, prednisone) is an important part of the management of almost all patients with brain metastases. […] Clinical studies have shown that surgery is beneficial for managing select patients with brain metastases. […] Radiation therapy has been a mainstay of treatment for brain metastases for many years. […] Radiosurgery is an important therapy for the treatment of metastatic brain tumors.

• #26 Breast Cancer and Metastasis to the Brain

  https://www.verywellhealth.com/breast-cancer-spread-to-the-brain-4160052

  Nobody is sure why some people develop brain metastases and others do not. We do know of some risk factors, however. Brain metastases are more likely in young women with breast cancer, and the incidence is exceptionally high in those diagnosed before the age of 35. Tumors that are more likely to spread to the brain include those with a higher tumor grade, those which are HER2 positive and estrogen receptor negative, and those which are triple negative. […] Breast cancer is more likely to spread to the brain for those with larger breast tumors (greater than 2 cm in diameter), as well as for people who have positive lymph nodes at the time of their initial diagnosis. A shorter time between the original early-stage cancer and the recurrence is also linked with a greater risk of brain metastases.

• #27 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Certain characteristics of both the patient and the cancer will affect the patient’s prognosis as well as eligibility for treatment. The following factors are associated with better outcomes: Younger age: less than 60 years old; Fewer vs. more brain metastases: fewer than three lesions; No extracranial disease (extracranial is the presence of disease outside the cranium); Normal LDH; High—greater than 70—Karnofsky Performance Status (KPS) score (Karnofsky assesses the functional status of a patient).

• #28 Brain Metastases Causes, Symptoms, and Treatments | UPMC Hillman

  https://hillman.upmc.com/cancer-care/brain-nervous-system/brain-tumor/brain-metastases

  Brain metastases are tumors that originate in a different part of the body and then spread to the brain. […] Although any cancer can spread to the brain, lung, colon, kidney, and melanoma cancers are the most likely to cause brain metastases. […] The longer cancer is in the body, the greater the chance it will spread to other parts, including the brain. […] As people are living longer with cancer, due to treatment advances, brain metastases are becoming more common. […] Studies have found that cancer will spread to the brain in about 10 to 20% of people who have cancer. […] Some cancers are much more likely to spread to the brain, such as breast cancer, colon and rectal cancer, kidney cancer, lung cancer, which accounts for half of all brain metastases, and skin cancer. […] Many studies are looking into ways to reduce the spread of cancers to the brain. […] Potential options include radiation to the brain and treating the primary cancer with certain types of chemotherapy.

• #29 Brain Metastasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1157902-overview

  Brain metastases are cancer cells that have spread to the brain from primary tumors in other organs in the body. It is estimated that 20%40% of all patients diagnosed with a primary cancer will develop a secondary cancer in the brain. […] Brain metastases account for 20% of cancer deaths annually, a rate that can be traced to an increase in the median survival of patients with cancer because of modern therapies, increased availability of advanced imaging techniques for early detection, and vigilant surveillance protocols for monitoring recurrence. […] The most common origins of brain metastasis are systemic cancer of the lung, breast, skin, or GI tract. […] Primary lung tumors account for 50% of all metastatic brain tumors. Lung cancer is the most common origin of metastatic disease.

• #30 Diagnosis and management of brain metastases: an updated review from a radiation oncology perspective

  https://www.oaepublish.com/articles/2394-4722.2019.20

  Brain metastasis are the most common intracranial malignancy in the adult population. Their incidence has increased dramatically over the last 20 years, as a result of the increasing number of cases stemming from lung and breast cancer together with the higher cancer survival rates due to diagnostic and therapeutic advances. More than 40% of cancer patients develop brain metastases during the course of their disease: specifically, they appear in 50% of patients with lung cancer, more than 25% of patients with breast cancer, and 20% of patients with melanoma. […] The incidence of brain metastasis has been on the rise the last 20 years, resulting from an increase in the number of cases of lung and breast cancer and the fact that cancer survival rates have been increasing thanks to new therapeutic advances and the availability of central nervous system imaging technologies for diagnosis. More than 40% of patients with cancer develop brain metastases: specifically, they appear in 50% of patients with lung cancer, more than 25% of patients with breast cancer, and 20% of patients with melanoma.

• #31 Resection of isolated brain metastases in non-small cell lung cancer (NSCLC) patients – evaluation of outcome and prognostic factors: A retrospective multicenter study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253601

  Patients with more than one brain metastasis had a significantly worse outcome compared to those with a singular metastasis (median OS 13.5 vs. 19.5 months, p = 0.006). […] Addressing prognostic factors and the histologic type of cancer, some studies show a better prognosis of patients with adenocarcinoma, compared to those with squamous cell carcinoma. […] The overall complication rate in patients undergoing surgical resection of brain metastases range from 5% up to 40%.

• #32 Risk factors for breast cancer brain metastases: a systematic review | Oncotarget

  https://www.oncotarget.com/article/27453/text/

  Background: Brain metastasis (BM) is an increasingly common and devastating complication of breast cancer (BC). […] Young age, estrogen receptor negativity (ER-), overexpression of human epidermal factor (HER2+), and higher presenting stage, histological grade, tumor size, Ki67 labeling index and nodal involvement were consistently found to be independent risk factors of BCBM. […] In contrast, young age, hormone receptor negative (HR-) status, higher presenting stage, nodal involvement and development of liver metastasis were the most important risk factors for BM in HER2-positive patients. […] The study provides a comprehensive and individual evaluation of the risk factors that could support the design of screening tools and interventional trials for early detection of BCBM. […] Patients typically present with progressive neurologic and motor deficits, with symptoms ranging from headache and nausea to personality change, seizures, paralysis and cognitive impairment.

• #33 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment. […] More than 60% of all Stage IV melanoma patients will develop brain metastases at some point, but certain factors increase the risk: The primary tumor was on the head, neck, trunk, or abdomen; The primary tumor was ulcerated, deep, or invasive; The LDH is elevated at diagnosis of unresectable Stage III or Stage IV; The presence of NRAS or BRAF mutation; The melanoma has spread to the internal organs. […] There are several potential reasons: There is growing evidence that brain tumors are very different from tumors in other parts of the body and may need to be treated differently; The brain looks familiar. Melanocytes arise from the same part of the early embryo as the brain, so the brain might be a very natural environment for melanoma tumors to grow in; Often, by the time a patient first exhibits symptoms, s/he already has multiple lesions, not just one; Brain metastases tend to be very aggressive and even a small increase in their size can cause more symptoms; The brain has many defenses to reduce the penetration of harmful substances. This system is called the blood-brain-barrier, and also it prevents many medications from entering the brain; Treatment options may damage surrounding normal tissue and have significant impact on the quality of life.

• #34 Metastatic Brain Tumors > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/metastatic-brain-tumors

  When a metastatic brain tumor is diagnosed, it means that cancer cells from another organ have spread to the brain. […] Up to 20% of people who have cancer will develop a metastatic brain tumor. The cells that form metastatic brain tumors can originate from any organ, but most often they come from lung, breast, skin, ovarian, and intestinal cancers. […] Doctors do not yet know why some cancers spread to the brain and others do not. What is known, however, is that brain metastases can occur in any long-term cancer survivor. […] In addition, certain cancers, such as melanoma, or some subsets of other cancers such as EGFR-mutant lung cancer and HER2-positive breast cancer also seem to be more likely to spread to the brain.

• #35 Breast Cancer and Metastasis to the Brain

  https://www.verywellhealth.com/breast-cancer-spread-to-the-brain-4160052

  Nobody is sure why some people develop brain metastases and others do not. We do know of some risk factors, however. Brain metastases are more likely in young women with breast cancer, and the incidence is exceptionally high in those diagnosed before the age of 35. Tumors that are more likely to spread to the brain include those with a higher tumor grade, those which are HER2 positive and estrogen receptor negative, and those which are triple negative. […] Breast cancer is more likely to spread to the brain for those with larger breast tumors (greater than 2 cm in diameter), as well as for people who have positive lymph nodes at the time of their initial diagnosis. A shorter time between the original early-stage cancer and the recurrence is also linked with a greater risk of brain metastases.

• #36 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment. […] More than 60% of all Stage IV melanoma patients will develop brain metastases at some point, but certain factors increase the risk: The primary tumor was on the head, neck, trunk, or abdomen; The primary tumor was ulcerated, deep, or invasive; The LDH is elevated at diagnosis of unresectable Stage III or Stage IV; The presence of NRAS or BRAF mutation; The melanoma has spread to the internal organs. […] There are several potential reasons: There is growing evidence that brain tumors are very different from tumors in other parts of the body and may need to be treated differently; The brain looks familiar. Melanocytes arise from the same part of the early embryo as the brain, so the brain might be a very natural environment for melanoma tumors to grow in; Often, by the time a patient first exhibits symptoms, s/he already has multiple lesions, not just one; Brain metastases tend to be very aggressive and even a small increase in their size can cause more symptoms; The brain has many defenses to reduce the penetration of harmful substances. This system is called the blood-brain-barrier, and also it prevents many medications from entering the brain; Treatment options may damage surrounding normal tissue and have significant impact on the quality of life.

• #37 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment. […] More than 60% of all Stage IV melanoma patients will develop brain metastases at some point, but certain factors increase the risk: The primary tumor was on the head, neck, trunk, or abdomen; The primary tumor was ulcerated, deep, or invasive; The LDH is elevated at diagnosis of unresectable Stage III or Stage IV; The presence of NRAS or BRAF mutation; The melanoma has spread to the internal organs. […] There are several potential reasons: There is growing evidence that brain tumors are very different from tumors in other parts of the body and may need to be treated differently; The brain looks familiar. Melanocytes arise from the same part of the early embryo as the brain, so the brain might be a very natural environment for melanoma tumors to grow in; Often, by the time a patient first exhibits symptoms, s/he already has multiple lesions, not just one; Brain metastases tend to be very aggressive and even a small increase in their size can cause more symptoms; The brain has many defenses to reduce the penetration of harmful substances. This system is called the blood-brain-barrier, and also it prevents many medications from entering the brain; Treatment options may damage surrounding normal tissue and have significant impact on the quality of life.

• #38

  https://link.springer.com/article/10.1007/s00384-023-04451-4

  The study aimed to investigate the clinical characteristics, prognostic factors, survival times, and therapy outcomes of brain metastases (BM) from colorectal cancer (CRC). […] In patients with BM from CRC, lung metastases (13/25) occurred at a higher frequency than liver metastases (8/25) and bone metastases (6/25). […] Univariate analysis demonstrated that the prognosis of patients was related to the KPS score, the number of BM, the treatment methods, and the occurrence of lung metastasis. […] The multivariate analysis revealed that the treatment modality and lung metastasis were independent prognostic factors for CRC patients with BM. […] Patients with left-sided CRC, especially those with lung metastases, are prone to brain metastases, and patients with brain metastases as the first metastatic site have a higher rate of supratentorial metastases. […] The prognosis of CRC patients with BM and lung metastases is poor, and comprehensive treatment based on surgery could significantly prolong patients survival time.

• #39

  https://journals.lww.com/eurjcancerprev/fulltext/2023/09000/risk_and_prognostic_factors_of_brain_metastasis_in.12.aspx

  Brain is a common metastasis site in lung cancer patients. However, homogeneous and heterogeneous risk/prognostic factors of brain metastasis for lung cancer patients have not been comprehensively elucidated. This study aimed to explore the brain metastasis risk and prognostic factors in lung cancer patients using the Surveillance, Epidemiology, and End Results (SEER) database. […] A total of 10818 (14.1%) patients with brain metastasis were diagnosed among 76483 lung cancer patients. For nonsmall-cell lung carcinoma (NSCLC), distant liver/bone/lymph node metastases, higher T, N stages were risk factors. Black race, bone metastases and distant lymph node metastases and T4 were brain metastasis risk factors for SCLC patients. […] In this study, we analyzed the homogeneous and heterogeneous risk/prognostic factors of brain metastasis in lung cancer patients. What is more, our results showed that surgery of primary site was associated with longer OS of NSCLC patients with brain metastasis.

• #40 Breast Cancer and Metastasis to the Brain

  https://www.verywellhealth.com/breast-cancer-spread-to-the-brain-4160052

  Nobody is sure why some people develop brain metastases and others do not. We do know of some risk factors, however. Brain metastases are more likely in young women with breast cancer, and the incidence is exceptionally high in those diagnosed before the age of 35. Tumors that are more likely to spread to the brain include those with a higher tumor grade, those which are HER2 positive and estrogen receptor negative, and those which are triple negative. […] Breast cancer is more likely to spread to the brain for those with larger breast tumors (greater than 2 cm in diameter), as well as for people who have positive lymph nodes at the time of their initial diagnosis. A shorter time between the original early-stage cancer and the recurrence is also linked with a greater risk of brain metastases.

• #41 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment. […] More than 60% of all Stage IV melanoma patients will develop brain metastases at some point, but certain factors increase the risk: The primary tumor was on the head, neck, trunk, or abdomen; The primary tumor was ulcerated, deep, or invasive; The LDH is elevated at diagnosis of unresectable Stage III or Stage IV; The presence of NRAS or BRAF mutation; The melanoma has spread to the internal organs. […] There are several potential reasons: There is growing evidence that brain tumors are very different from tumors in other parts of the body and may need to be treated differently; The brain looks familiar. Melanocytes arise from the same part of the early embryo as the brain, so the brain might be a very natural environment for melanoma tumors to grow in; Often, by the time a patient first exhibits symptoms, s/he already has multiple lesions, not just one; Brain metastases tend to be very aggressive and even a small increase in their size can cause more symptoms; The brain has many defenses to reduce the penetration of harmful substances. This system is called the blood-brain-barrier, and also it prevents many medications from entering the brain; Treatment options may damage surrounding normal tissue and have significant impact on the quality of life.

• #42 Brain Metastasis: Causes & Treatments – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/brain-metastasis-causes-treatments/

  Brain metastasis happens when cancer cells move from other tumors to the brain. This is called cancer cell migration. Cancers like lung, breast, melanoma, renal, and colorectal are more likely to spread to the brain. […] Cancer cells travel through the bloodstream or lymphatic system. They change to fit the brain’s special environment. This lets them grow and thrive in the brain. […] Molecular and genetic factors also help cancer spread. Some genes make brain cancer more aggressive. This makes it harder to treat. […] By finding these genetic changes, doctors can create new treatments. These treatments aim to stop cancer from spreading. […] Here are some important factors in brain metastasis and cancer cell migration: Changes in cell adhesion molecules help cancer cells move through the bloodstream. Enzymes break down the brain’s outer layer, letting cancer cells invade. Cancer cells create safe spots in the brain. This helps them grow without being caught by the immune system.

• #43 Brain Metastasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1157902-overview

  Breast tumor is the main source of metastatic disease in women, followed by melanoma, renal, and colorectal tumors. […] Melanoma commonly metastasizes to the brain. Melanoma has an increased incidence among other systemic cancers in terms of metastasizing to the brain. […] Cancer-cell trafficking may not be entirely random, and factors produced by stromal cells may guide their final destination in the brain. […] Different tumors metastasize preferentially to different organs. […] Recently, it has been shown that metastases may have originated from cancer initiating cells, which are more resistant to therapy by virtue of their stemlike properties. […] Cancer cells have been shown to recruit bone marrowderived cells to modify the microenvironment of distant recipient site; the formation of a premetastatic niche by alternating the level of fibronectin and making the site more favorable for the colonization of metastatic tumor.

• #44 Associated Factors of Spontaneous Hemorrhage in Brain Metastases in Patients with Lung Adenocarcinoma

  https://www.mdpi.com/2072-6694/15/3/619

  Brain metastases (BMs) are the most common intracranial tumors in adult patients and typically arise from lung cancer. Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancer cases. The prevalence of BMs at initial presentation is 15–20%, and up to 40% of patients eventually develop BMs during the course of NSCLC. In particular, patients with adenocarcinoma have a higher risk of BM development than those with other histologic subtypes. […] The pathophysiology of hemorrhage in BMs remains unclear. One theory is that abnormal tumor vascularization may play an important role as newly formed vessels within the tumor mass are characterized by numerous structural abnormalities and may be thin-walled, poorly formed, or dilated, leading to their dysfunction. In metastatic brain tumors, vascular endothelial growth factor (VEGF) and metalloproteinase 2-mediated hypoxic signaling pathway may result in the loss of vascular integrity, leading to tumor-associated hemorrhage and necrosis.

• #45 Brain Metastases | Living Beyond Breast Cancer

  https://www.lbbc.org/about-breast-cancer/types-breast-cancer/metastatic-breast-cancer/brain-metastases

  Brain metastases are areas of cancer that develop when breast cancer cells spread to the brain and form tumors. […] Right now, doctors don’t know exactly how breast cancer cells spread to the brain and begin to grow. The small blood vessels in the brain have a protective inner lining known as the blood-brain barrier, which keeps harmful toxins from getting into the brain. How breast cancer cells break through this barrier isn’t well understood. But it is the subject of ongoing research. Some researchers believe certain genetic pathways may help breast cancer cells cross through the blood-brain barrier to cause brain mets. […] While about 15-20 percent of women diagnosed with metastatic breast cancer are eventually diagnosed with brain metastasis, some have a higher risk of developing it than others. Doctors don’t know why, but breast cancer that is both HER2-positive and hormone receptor-negative, or triple-negative, is more likely to spread to the brain than hormone receptor-positive breast cancer.

• #46 Brain Metastases | Living Beyond Breast Cancer

  https://www.lbbc.org/about-breast-cancer/types-breast-cancer/metastatic-breast-cancer/brain-metastases

  Brain metastases are areas of cancer that develop when breast cancer cells spread to the brain and form tumors. […] Right now, doctors don’t know exactly how breast cancer cells spread to the brain and begin to grow. The small blood vessels in the brain have a protective inner lining known as the blood-brain barrier, which keeps harmful toxins from getting into the brain. How breast cancer cells break through this barrier isn’t well understood. But it is the subject of ongoing research. Some researchers believe certain genetic pathways may help breast cancer cells cross through the blood-brain barrier to cause brain mets. […] While about 15-20 percent of women diagnosed with metastatic breast cancer are eventually diagnosed with brain metastasis, some have a higher risk of developing it than others. Doctors don’t know why, but breast cancer that is both HER2-positive and hormone receptor-negative, or triple-negative, is more likely to spread to the brain than hormone receptor-positive breast cancer.

• #47 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment. […] More than 60% of all Stage IV melanoma patients will develop brain metastases at some point, but certain factors increase the risk: The primary tumor was on the head, neck, trunk, or abdomen; The primary tumor was ulcerated, deep, or invasive; The LDH is elevated at diagnosis of unresectable Stage III or Stage IV; The presence of NRAS or BRAF mutation; The melanoma has spread to the internal organs. […] There are several potential reasons: There is growing evidence that brain tumors are very different from tumors in other parts of the body and may need to be treated differently; The brain looks familiar. Melanocytes arise from the same part of the early embryo as the brain, so the brain might be a very natural environment for melanoma tumors to grow in; Often, by the time a patient first exhibits symptoms, s/he already has multiple lesions, not just one; Brain metastases tend to be very aggressive and even a small increase in their size can cause more symptoms; The brain has many defenses to reduce the penetration of harmful substances. This system is called the blood-brain-barrier, and also it prevents many medications from entering the brain; Treatment options may damage surrounding normal tissue and have significant impact on the quality of life.

• #48 Brain metastases cause severe brain damage that can be inhibited by treatment – ecancer

  https://ecancer.org/en/news/19086-brain-metastases-cause-severe-brain-damage-that-can-be-inhibited-by-treatment

  Brain metastases cause severe brain damage that can be inhibited by treatment. […] Researchers from the University of Seville and the University of Oxford have described how the presence of brain metastases causes acute cerebrovascular dysfunction from the early stages of the disease. […] The study, whose main author was Manuel Sarmiento Soto, Marie Curie researcher and member of the Group on Mechanisms of Cell Death in Neurodegenerative Diseases at the University of Seville, shows that this alteration is chiefly caused by the activation of cells called astrocytes. […] The key role played by the astrocytes in brain metastasis has been thoroughly proven. […] For example, in the specific case of brain metastases from breast cancer, when the tumour cells reach the brain they produce a significant activation of astrocytes causing a dysregulation of the afferent blood flow. […] This causes a decrease in brain perfusion in the areas adjacent to the brain metastases, with the consequent damage that this drop could cause to neurons and other brain cells.

• #49 Perilesional edema in brain metastases: potential causes and implications for treatment with immune therapy | Journal for ImmunoTherapy of Cancer

  https://jitc.bmj.com/content/7/1/200

  Brain metastases (BMs) are the most common intracerebral malignancies in adults; melanoma has the highest propensity for brain dissemination, followed by non-small cell lung cancer (NSCLC). […] Neurologic symptoms from BMs are often caused by edema rather than from the tumor itself, as edema volume can be several-fold greater than tumor volume. […] Little is known about the relationship between tumor-associated vasogenic edema and tumor volume or survival. […] Defects in BBB inter-endothelial tight junctions are thought to cause peritumoral edema. […] Factors beyond tumor size that might cause edema include an abundance of neo-vessels and secretion of factors from tumor or immune cells that disrupt the BBB. […] We found no association between edema and micro-vessel density by CD34 staining of tumor-associated blood vessels.

• #50 Associated Factors of Spontaneous Hemorrhage in Brain Metastases in Patients with Lung Adenocarcinoma

  https://www.mdpi.com/2072-6694/15/3/619

  Brain metastases (BMs) are the most common intracranial tumors in adult patients and typically arise from lung cancer. Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancer cases. The prevalence of BMs at initial presentation is 15–20%, and up to 40% of patients eventually develop BMs during the course of NSCLC. In particular, patients with adenocarcinoma have a higher risk of BM development than those with other histologic subtypes. […] The pathophysiology of hemorrhage in BMs remains unclear. One theory is that abnormal tumor vascularization may play an important role as newly formed vessels within the tumor mass are characterized by numerous structural abnormalities and may be thin-walled, poorly formed, or dilated, leading to their dysfunction. In metastatic brain tumors, vascular endothelial growth factor (VEGF) and metalloproteinase 2-mediated hypoxic signaling pathway may result in the loss of vascular integrity, leading to tumor-associated hemorrhage and necrosis.

• #51 Perilesional edema in brain metastases: potential causes and implications for treatment with immune therapy | Journal for ImmunoTherapy of Cancer

  https://jitc.bmj.com/content/7/1/200

  Brain metastases (BMs) are the most common intracerebral malignancies in adults; melanoma has the highest propensity for brain dissemination, followed by non-small cell lung cancer (NSCLC). […] Neurologic symptoms from BMs are often caused by edema rather than from the tumor itself, as edema volume can be several-fold greater than tumor volume. […] Little is known about the relationship between tumor-associated vasogenic edema and tumor volume or survival. […] Defects in BBB inter-endothelial tight junctions are thought to cause peritumoral edema. […] Factors beyond tumor size that might cause edema include an abundance of neo-vessels and secretion of factors from tumor or immune cells that disrupt the BBB. […] We found no association between edema and micro-vessel density by CD34 staining of tumor-associated blood vessels.

• #52 Nationwide patterns of hemorrhagic stroke among patients hospitalized with brain metastases: influence of primary cancer diagnosis and anticoagulation | Scientific Reports

  https://www.nature.com/articles/s41598-020-67316-8

  Brain metastases can contribute to a decreased quality of life for patients with cancer, often leading to malaise, neurologic dysfunction, or death. […] Intracerebral hemorrhage (ICH) is an especially feared complication in patients with brain metastases given the potential for significant morbidity and mortality. […] ICH was found to be positively associated with having a diagnosis of melanoma (odds ratio [OR] 5.01; 95% Confidence Interval [CI] 3.50-7.61) and kidney cancer (OR 2.50; 95% CI 1.69-3.72). […] Patients on long-term anticoagulation had a higher risk of ICH (OR 1.49; CI 1.15-1.91). […] Some studies have suggested that patients with brain metastases and primary cancers from melanoma, renal cell carcinoma, choriocarcinoma, thyroid carcinoma, and hepatocellular carcinoma are more likely to bleed spontaneously and may be at high risk of ICH with anticoagulation.

• #53 Nationwide patterns of hemorrhagic stroke among patients hospitalized with brain metastases: influence of primary cancer diagnosis and anticoagulation | Scientific Reports

  https://www.nature.com/articles/s41598-020-67316-8

  Brain metastases can contribute to a decreased quality of life for patients with cancer, often leading to malaise, neurologic dysfunction, or death. […] Intracerebral hemorrhage (ICH) is an especially feared complication in patients with brain metastases given the potential for significant morbidity and mortality. […] ICH was found to be positively associated with having a diagnosis of melanoma (odds ratio [OR] 5.01; 95% Confidence Interval [CI] 3.50-7.61) and kidney cancer (OR 2.50; 95% CI 1.69-3.72). […] Patients on long-term anticoagulation had a higher risk of ICH (OR 1.49; CI 1.15-1.91). […] Some studies have suggested that patients with brain metastases and primary cancers from melanoma, renal cell carcinoma, choriocarcinoma, thyroid carcinoma, and hepatocellular carcinoma are more likely to bleed spontaneously and may be at high risk of ICH with anticoagulation.

• #54 Associated Factors of Spontaneous Hemorrhage in Brain Metastases in Patients with Lung Adenocarcinoma

  https://www.mdpi.com/2072-6694/15/3/619

  Brain metastases (BMs) are the most common intracranial tumors in adult patients and typically arise from lung cancer. Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancer cases. The prevalence of BMs at initial presentation is 15–20%, and up to 40% of patients eventually develop BMs during the course of NSCLC. In particular, patients with adenocarcinoma have a higher risk of BM development than those with other histologic subtypes. […] The pathophysiology of hemorrhage in BMs remains unclear. One theory is that abnormal tumor vascularization may play an important role as newly formed vessels within the tumor mass are characterized by numerous structural abnormalities and may be thin-walled, poorly formed, or dilated, leading to their dysfunction. In metastatic brain tumors, vascular endothelial growth factor (VEGF) and metalloproteinase 2-mediated hypoxic signaling pathway may result in the loss of vascular integrity, leading to tumor-associated hemorrhage and necrosis.

• #55 Associated Factors of Spontaneous Hemorrhage in Brain Metastases in Patients with Lung Adenocarcinoma

  https://www.mdpi.com/2072-6694/15/3/619

  We also found that EGFR-TKI therapy was associated with hemorrhage in BMs from lung adenocarcinomas, particularly when combined with radiation therapy. In a case report of two patients with lung cancer, hemorrhagic BMs developed 1 month after a combination of EGFR-TKI and radiation therapies. Thus, the combination of EGFR-TKI and radiation therapies may be the cause of hemorrhage in BMs. […] We demonstrated that hemorrhage in BMs from NSCLC adenocarcinomas may be associated with larger BM size and combination therapy involving intracranial radiation exposure and TKI use. However, hemorrhage was not associated with patient prognosis.

• #56 Associated Factors of Spontaneous Hemorrhage in Brain Metastases in Patients with Lung Adenocarcinoma

  https://www.mdpi.com/2072-6694/15/3/619

  Brain metastases (BMs) are the most common intracranial tumors in adult patients and typically arise from lung cancer. Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancer cases. The prevalence of BMs at initial presentation is 15–20%, and up to 40% of patients eventually develop BMs during the course of NSCLC. In particular, patients with adenocarcinoma have a higher risk of BM development than those with other histologic subtypes. […] The pathophysiology of hemorrhage in BMs remains unclear. One theory is that abnormal tumor vascularization may play an important role as newly formed vessels within the tumor mass are characterized by numerous structural abnormalities and may be thin-walled, poorly formed, or dilated, leading to their dysfunction. In metastatic brain tumors, vascular endothelial growth factor (VEGF) and metalloproteinase 2-mediated hypoxic signaling pathway may result in the loss of vascular integrity, leading to tumor-associated hemorrhage and necrosis.

• #57 Brain metastases: an overview

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6093020/

  Brain metastases (BMs) are the most frequent cause of malignant tumor of the central nervous system (CNS), four-times higher than primary tumors; about 20-40% of patients with cancer will develop BM in their clinical course. […] Furthermore, the frequency of BM is increasing over the years as a result of the increase in overall survival (OS) in cancer patients and of the improvement in diagnostic tools for BM detecting, as magnetic resonance imaging (MRI). […] Primary tumors that most frequently metastasize to brain are in order of frequency: lung (50%), breast (15-25%), melanoma (5-20%) and, less frequently, testis, kidney, colon-rectum, thyroid, but more in general any cancer subtype can metastasize to the brain. […] In 15% of cases, the primary site is unknown. […] BMs usually develop in advanced stages of disease, less frequently BMs are the first clinical sign of cancer and/or synchronous with primary tumor diagnosis.

• #58 Brain Tumor Facts

  https://braintumor.org/brain-tumors/about-brain-tumors/brain-tumor-facts/

  Each year, approximately 70,000-200,000 patients are diagnosed with brain metastases (metastatic brain tumors/secondary brain tumors), while ~100,000 will die every year as the result of brain metastases. […] The incidence of brain metastases appears to be increasing. […] Several studies have cited that the percentage of patients with cancer who will develop brain metastases is anywhere from approximately 10% to 30%. […] Virtually all cancers have been associated with the ability to metastasize to the brain. […] These include melanoma (where its been estimated that most cases will metastasize to the brain), lung, breast, renal, and colorectal cancers. […] Metastatic brain tumors are five times more common than primary brain tumors (those that originate in the brain).

• #59 Brain Metastasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1157902-overview

  Brain metastases are cancer cells that have spread to the brain from primary tumors in other organs in the body. It is estimated that 20%40% of all patients diagnosed with a primary cancer will develop a secondary cancer in the brain. […] Brain metastases account for 20% of cancer deaths annually, a rate that can be traced to an increase in the median survival of patients with cancer because of modern therapies, increased availability of advanced imaging techniques for early detection, and vigilant surveillance protocols for monitoring recurrence. […] The most common origins of brain metastasis are systemic cancer of the lung, breast, skin, or GI tract. […] Primary lung tumors account for 50% of all metastatic brain tumors. Lung cancer is the most common origin of metastatic disease.

• #60 Brain Metastases Causes, Symptoms, and Treatments | UPMC Hillman

  https://hillman.upmc.com/cancer-care/brain-nervous-system/brain-tumor/brain-metastases

  Brain metastases are tumors that originate in a different part of the body and then spread to the brain. […] Although any cancer can spread to the brain, lung, colon, kidney, and melanoma cancers are the most likely to cause brain metastases. […] The longer cancer is in the body, the greater the chance it will spread to other parts, including the brain. […] As people are living longer with cancer, due to treatment advances, brain metastases are becoming more common. […] Studies have found that cancer will spread to the brain in about 10 to 20% of people who have cancer. […] Some cancers are much more likely to spread to the brain, such as breast cancer, colon and rectal cancer, kidney cancer, lung cancer, which accounts for half of all brain metastases, and skin cancer. […] Many studies are looking into ways to reduce the spread of cancers to the brain. […] Potential options include radiation to the brain and treating the primary cancer with certain types of chemotherapy.

• #61 Brain metastases: an overview

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6093020/

  Brain metastases (BMs) are the most frequent cause of malignant tumor of the central nervous system (CNS), four-times higher than primary tumors; about 20-40% of patients with cancer will develop BM in their clinical course. […] Furthermore, the frequency of BM is increasing over the years as a result of the increase in overall survival (OS) in cancer patients and of the improvement in diagnostic tools for BM detecting, as magnetic resonance imaging (MRI). […] Primary tumors that most frequently metastasize to brain are in order of frequency: lung (50%), breast (15-25%), melanoma (5-20%) and, less frequently, testis, kidney, colon-rectum, thyroid, but more in general any cancer subtype can metastasize to the brain. […] In 15% of cases, the primary site is unknown. […] BMs usually develop in advanced stages of disease, less frequently BMs are the first clinical sign of cancer and/or synchronous with primary tumor diagnosis.

• #62 Brain Metastasis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1157902-overview

  Brain metastases are cancer cells that have spread to the brain from primary tumors in other organs in the body. It is estimated that 20%40% of all patients diagnosed with a primary cancer will develop a secondary cancer in the brain. […] Brain metastases account for 20% of cancer deaths annually, a rate that can be traced to an increase in the median survival of patients with cancer because of modern therapies, increased availability of advanced imaging techniques for early detection, and vigilant surveillance protocols for monitoring recurrence. […] The most common origins of brain metastasis are systemic cancer of the lung, breast, skin, or GI tract. […] Primary lung tumors account for 50% of all metastatic brain tumors. Lung cancer is the most common origin of metastatic disease.

• #63 Metastatic Brain Tumor (Brain Metastases) – Symptoms & Causes

  https://www.uchealth.com/en/conditions/metastatic-brain-tumor

  A metastatic brain tumor is a type of brain tumor that begins elsewhere in the body and spreads to the brain through the bloodstream or lymphatic system. […] Other types of brain tumors begin as cancers somewhere else in the body. These can start in the lung, breast, skin, kidney, colon, or other body parts. […] Metastatic brain tumors happen most often in lung cancer. But these tumors can occur in many other types of cancer, such as melanoma or breast cancer. […] Cancer may spread to the brain through your lymph system or your bloodstream. Or it may travel to the brain from a nearby tissue. Metastatic brain tumors are becoming more common because people are living longer after having cancer somewhere else in their body.

• #64 Brain metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-metastases?lang=us

  Brain metastases are estimated to account for approximately 25-50% of intracranial tumors in hospitalized patients. […] The true incidence of brain metastases is unknown, but estimates are as high as 200,000 cases per year in the United States alone. […] Five primary tumors account for 80% of brain metastases: lung cancer, renal cell carcinoma, breast cancer, melanoma, and gastrointestinal tract adenocarcinomas (the majority are colorectal carcinoma). […] A population-based study of 169,444 cancer patients from 1973-2001 in Detroit revealed that overall, 10% of patients diagnosed with one of these five primaries went on to develop brain metastases. Specifically, 20% of lung cancers, 7% of melanomas, 7% of renal cancers, 5% of breast cancers and 2% of colorectal cancers metastasized to the brain. […] In patients with known malignancies, the brain can sometimes act as a reservoir for metastatic disease as traditional chemotherapy regimens can have poor permeability through the blood-brain barrier. This can lead to presentation with cerebral metastases, even with quiescent systemic disease.

• #65 Brain metastases: an overview

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6093020/

  Brain metastases (BMs) are the most frequent cause of malignant tumor of the central nervous system (CNS), four-times higher than primary tumors; about 20-40% of patients with cancer will develop BM in their clinical course. […] Furthermore, the frequency of BM is increasing over the years as a result of the increase in overall survival (OS) in cancer patients and of the improvement in diagnostic tools for BM detecting, as magnetic resonance imaging (MRI). […] Primary tumors that most frequently metastasize to brain are in order of frequency: lung (50%), breast (15-25%), melanoma (5-20%) and, less frequently, testis, kidney, colon-rectum, thyroid, but more in general any cancer subtype can metastasize to the brain. […] In 15% of cases, the primary site is unknown. […] BMs usually develop in advanced stages of disease, less frequently BMs are the first clinical sign of cancer and/or synchronous with primary tumor diagnosis.

• #66 Management of Brain Metastases

  https://www.cancernetwork.com/view/management-brain-metastases

  In the majority (80%) of patients, brain metastases develop after the diagnosis of systemic cancer (metachronous presentation). […] For patients who present with brain metastases without a known primary tumor, the lung should be the focus of the evaluation. […] The management of patients with brain metastases can be divided into symptomatic and definitive therapy. […] The definitive management of brain metastases is directed at relieving neurologic symptoms and achieving long-term tumor control. […] The role of chemotherapy in the treatment of patients with brain metastases has not been clearly defined. […] Overall, these studies suggest that chemotherapy has some activity against brain metastases, especially those from chemosensitive tumors, such as breast cancer, small-cell lung cancer, and choriocarcinoma.

• #67 Brain metastases. Causes, symptoms and treatment. Cancer Center Clínica Universidad de Navarra

  https://cancercenter.cun.es/en/all-about-cancer/cancer-types/brain-metastases

  Brain metastasis is the spread of cancer cells from a tumour in another part of the body to the brain. They are also the most common brain tumours in adults. […] The tumour types that most frequently develop brain metastases are melanoma, lung cancer, breast cancer and renal cancer. While breast and renal carcinoma tend to cause single metastases, melanoma and lung cancer produce multiple metastases. […] The time interval between the diagnosis of the primary tumour and the appearance of the brain metastasis(es) depends on the type of primary tumour: for example, breast cancer has an average interval of 3 years while lung cancer has an average interval of only 4 to 10 months. […] The treatment of choice, whenever possible, is surgery. Its success is based on a good surgical technique in conjunction with the use of new technological equipment for the location of the lesion (neuronavigation), the location of eloquent areas (tractography and functional resonance), and neurophysiological monitoring. […] The alternatives to surgery, when this is not possible, are holocranial radiotherapy, stereotactic radiotherapy and radiosurgery, which alone and/or in combination with chemotherapy, can achieve adequate local control of the disease.

• #68 Brain metastases: an overview

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6093020/

  Brain metastases (BMs) are the most frequent cause of malignant tumor of the central nervous system (CNS), four-times higher than primary tumors; about 20-40% of patients with cancer will develop BM in their clinical course. […] Furthermore, the frequency of BM is increasing over the years as a result of the increase in overall survival (OS) in cancer patients and of the improvement in diagnostic tools for BM detecting, as magnetic resonance imaging (MRI). […] Primary tumors that most frequently metastasize to brain are in order of frequency: lung (50%), breast (15-25%), melanoma (5-20%) and, less frequently, testis, kidney, colon-rectum, thyroid, but more in general any cancer subtype can metastasize to the brain. […] In 15% of cases, the primary site is unknown. […] BMs usually develop in advanced stages of disease, less frequently BMs are the first clinical sign of cancer and/or synchronous with primary tumor diagnosis.

• #69 Management of Brain Metastases

  https://www.cancernetwork.com/view/management-brain-metastases

  The median survival of patients with untreated brain metastases is approximately 1 month. […] The addition of steroids increases survival to 2 months, while whole-brain radiation further improves survival to 3 to 6 months. […] Patients with a single brain metastasis and limited extracranial disease who are treated with surgery and whole-brain irradiation have a median survival of approximately 10 to 16 months.

• #70 Management of Brain Metastases

  https://www.cancernetwork.com/view/management-brain-metastases

  The median survival of patients with untreated brain metastases is approximately 1 month. […] The addition of steroids increases survival to 2 months, while whole-brain radiation further improves survival to 3 to 6 months. […] Patients with a single brain metastasis and limited extracranial disease who are treated with surgery and whole-brain irradiation have a median survival of approximately 10 to 16 months.

• #71 30-day mortality in patients treated for brain metastases: extracranial causes dominate | Radiation Oncology | Full Text

  https://ro-journal.biomedcentral.com/articles/10.1186/s13014-022-02062-x

  The cause of death was unrelated to brain metastases in 61%. […] Extracranial tumor progression was the prevailing cause of 30-day mortality and few, if any deaths could be considered relatively unexpected when looking at the complete oncological picture.

• #72 Brain metastases: an overview

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6093020/

  The most important prognostic factors are key performance status (KPS), the number of BM, absence of systemic metastases, primary tumor control and age. […] The treatment of BM should always be individualized for each patient, according to the different sensitivity of the primary cancer to RT and/or chemotherapy (CT), the different clinical history (extracranial disease control, previous treatments, survival, disease-free interval) and especially to the number of metastases. […] Systemic therapy is rarely used as first-line approach in patients with BM, especially as single treatment. […] For these reasons, chemotherapy is usually considered as the last therapeutic option when surgery or RT are not possible. […] In the last decades, novel agents such as tyrosine kinase inhibitors or monoclonal antibodies have shown increase in overall response rate and overall survival in Phase IIIII trials.

• #73 Factors associated with the local control of brain metastases: a systematic search and machine learning application | BMC Medical Informatics and Decision Making | Full Text

  https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02579-z

  Brain metastases represent the most common intracranial tumor in adults. An estimated 20% of all patients with cancer will develop brain metastases. Although brain metastases can occur from any cancer, the three most common primary tumors associated with brain metastases are lung (20-56% of patients), breast (5-20%) and melanoma (7-16%). Advances in the treatment of primary tumors have led to prolonged life expectancy and therefore increased the probability of developing brain metastases. The overall prognosis for patients with brain metastases remains poor. Brain metastases account for a disproportionately high percentage of morbidity and mortality among patients with cancer, with dismal 2- and 5-year survival rates of 8.1% and 2.4% respectively after diagnosis. […] Conventional local treatment options for brain metastases include surgical resection, Whole Brain Radiotherapy (WBRT), Stereotactic Radiotherapy (SRT), or a combination of these. Irrespective of the treatment type, local control (LC) of brain metastases remains an important clinical endpoint. LC is defined as the freedom from the development of new lesions within the field treated with SRT or the absence of progression in preexisting metastases. The prediction of the LC of brain metastases after treatment has important practical implications for patients and clinicians. A predictive capability of the treatment outcome of brain metastases may provide a decision tool to clinicians for the effective management of patient care with the most desirable treatment outcome. If LC can be predicted, the treatment plan can be modified to improve LC by, for example, increasing the dose. The complexity of predicting LC post-treatment remains, however, a critical challenge.

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