Materiały źródłowe

• #1 Treatment of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5087313/

  Brain metastases (BMs) occur in 10% to 20% of adult patients with cancer, and with increased surveillance and improved systemic control, the incidence is likely to grow. Despite multimodal treatment, prognosis remains poor. Current evidence supports use of whole-brain radiation therapy when patients present with multiple BMs. However, its associated cognitive impairment is a major deterrent in patients likely to live longer than 6 months. […] In patients with oligometastases (one to three metastases) and even some with multiple lesions less than 3 to 4 cm, especially if the primary tumor is considered radiotherapy resistant, stereotactic radiosurgery is recommended; if the BMs are greater than 4 cm, surgical resection with or without postoperative whole-brain radiation therapy should be considered.

• #2 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. In recent years, important advances have been made in the diagnosis and management of brain metastases. These advances include the widespread use of magnetic resonance imaging (MRI), enabling small metastases to be detected; the introduction of stereotactic radiosurgery; and the performance of studies that have clarified the role of surgery and postoperative radiation therapy for single brain metastases. As a result, most patients receive effective palliation, and the majority do not die from their brain metastases. However, further studies are needed to define the optimal role of conventional treatments and to develop more effective novel therapies.

• #3 Overview of the treatment of brain metastases – UpToDate

  https://www.uptodate.com/contents/overview-of-the-treatment-of-brain-metastases

  Survival of patients with brain metastases has improved since the era when whole brain radiation therapy (WBRT) was the mainstay of treatment and median overall survival was routinely less than six months. Based on contemporary data, median survival exceeds six months for all major cancer types and ranges from approximately 8 to 16 months, depending on the primary tumor, with many patients who respond well to systemic therapies surviving notably longer.

• #4 MD Anderson’s Brain Metastases Clinic offers treatment options for secondary brain tumors | MD Anderson Cancer Center

  https://www.mdanderson.org/publications/annual-report/annual-report-2019/new-clinic-expands-brain-metastasis-treatment-options.html

  In a single visit at the clinic, patients see a team of health care specialists to develop a treatment plan. […] One of the goals for our clinic is to facilitate treatment faster, says Hussein Tawbi, M.D., Ph.D., associate professor of Melanoma Medical Oncology and co-director of the clinic. […] Brain metastases, or secondary brain tumors, occur in 10% to 30% of adults with cancer. […] Historically, Tawbi notes, patients with multiple brain metastases have survived only three to six months after diagnosis. […] The combination of a difficult target and additional regulation has steered drug companies toward developing anti-cancer drugs that avoid the brain. […] A follow-up trial led by Michael Davies, M.D., Ph.D., chair of Melanoma Medical Oncology, showed that brain tumors shrank in 58% of stage IV melanoma patients with a specific mutation in their tumors, when treated with the targeted therapy combination.

• #5 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  Treatment for brain metastases can help ease symptoms, slow tumor growth and extend life. Even with successful treatment, they may return. That’s why your healthcare professional will follow you closely. […] Treatments will depend on the type, size, number and location of tumors. Healthcare professionals also consider your symptoms, health and treatment goals. […] Medicines can help control symptoms of brain metastases and make you more comfortable. Options might include: Steroids. These high-dose medicines also are called corticosteroids. They may decrease swelling in the brain caused by brain metastases, helping to relieve symptoms. Anti-seizure drugs. These medicines may help control seizures if you have any. […] Surgery may be an option if a tumor is easily reachable and fits into your overall cancer care plan. The surgeon will remove as much tumor as possible. Surgery may help improve symptoms and help with diagnosis. It is combined with other treatments.

• #6 Treatment of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5087313/

  There is increasing evidence that systemic therapy, including targeted therapy and immunotherapy, is effective against BM and may be an early choice, especially in patients with sensitive primary tumors. […] Regardless of treatment goals, use of corticosteroids or antiepileptic medications is helpful in symptomatic patients. […] Therapy for BM includes definitive treatment directed against the tumor itself and supportive treatment, including glucocorticoids, antiepileptic drugs (AEDs), and anticoagulants, to help reduce symptoms. […] Glucocorticoids improve neurologic symptoms in up to 75% of patients with cerebral edema and are indicated in any symptomatic patient. […] AEDs are indicated in the approximately 25% of patients who present with seizures. […] Patients with cancer are at increased risk of venous thromboembolism (VTE), which is an important cause of cancer-related mortality.

• #7 Brain Metastasis Treatment & Management: Medical Care, Surgical Care

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

  Medical treatments consist of symptomatic and systematic treatments. Other options are surgical treatments, radiation therapy (whole brain radiation, focal beam and stereotactic radiation therapy, eg, radiosurgery), chemotherapy, combined therapies, experimental therapies, and integration therapy. […] Integration therapy is a multidisciplinary approach with combination therapy of behavioral modification/coping, nutritional counseling, alternative medicine (herbal), physical therapy, and occupational therapy. […] Medical management of metastatic diseases has mainly focused on the treatment of cerebral edema, headache, and seizure. […] Dexamethasone is the treatment of choice. […] The optimal dosage of dexamethasone vasogenic edema is 4 mg given intravenously or orally every 6 hours after a loading dose of 10 mg.

• #8 Radiotherapeutic Treatment Approaches for Brain Metastases | Anticancer Research

  https://ar.iiarjournals.org/content/34/12/6913

  Despite numerous studies testing numerous combinations of dose and fractionation, a total dose of 30 Gy (300 cGy/fr) continues to be the standard in clinical practice. […] A significant difference in median survival was only demonstrated in the trial of Priestman et al. […] The side-effects of WBRT include hair loss, headache, nausea and vomiting, hearing loss, otitis, skin erythema, and transient neurological symptoms; therapy with corticosteroids should be continued during WBRT, to improve oedema and neurological deficits. […] The rationale for SRS alone is to achieve brain control without possible treatment toxicity, such as neurocognitive sequelae, of WBRT. […] Based on the above-mentioned data, for patients with one to three brain metastases, we recommend surgical resection followed by WBRT. WBRT plus SRS should be considered in patients with single brain metastases and good performance status. SRS plus a close follow-up or SRS boost to the postoperative site should also be considered. Patients with extracranial disease should be treated with WBRT alone. For patients with multiple (3) brain metastases, WBRT is mandatory.

• #9 Treatment of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5087313/

  There is increasing evidence that systemic therapy, including targeted therapy and immunotherapy, is effective against BM and may be an early choice, especially in patients with sensitive primary tumors. […] Regardless of treatment goals, use of corticosteroids or antiepileptic medications is helpful in symptomatic patients. […] Therapy for BM includes definitive treatment directed against the tumor itself and supportive treatment, including glucocorticoids, antiepileptic drugs (AEDs), and anticoagulants, to help reduce symptoms. […] Glucocorticoids improve neurologic symptoms in up to 75% of patients with cerebral edema and are indicated in any symptomatic patient. […] AEDs are indicated in the approximately 25% of patients who present with seizures. […] Patients with cancer are at increased risk of venous thromboembolism (VTE), which is an important cause of cancer-related mortality.

• #10 Treatment of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5087313/

  There is increasing evidence that systemic therapy, including targeted therapy and immunotherapy, is effective against BM and may be an early choice, especially in patients with sensitive primary tumors. […] Regardless of treatment goals, use of corticosteroids or antiepileptic medications is helpful in symptomatic patients. […] Therapy for BM includes definitive treatment directed against the tumor itself and supportive treatment, including glucocorticoids, antiepileptic drugs (AEDs), and anticoagulants, to help reduce symptoms. […] Glucocorticoids improve neurologic symptoms in up to 75% of patients with cerebral edema and are indicated in any symptomatic patient. […] AEDs are indicated in the approximately 25% of patients who present with seizures. […] Patients with cancer are at increased risk of venous thromboembolism (VTE), which is an important cause of cancer-related mortality.

• #11 Overview of the treatment of brain metastases – UpToDate

  https://www.uptodate.com/contents/overview-of-the-treatment-of-brain-metastases

  Overview of the treatment of brain metastases […] The primary approaches to the treatment of brain metastases for many years have included collaborative care with surgery and radiation therapy. Current management has evolved to also integrate upfront consideration of systemic therapies. […] While whole brain radiation therapy (WBRT) remains a primary treatment modality for many patients with a high intracranial tumor burden, the routine role of WBRT as adjunctive therapy in patients who are candidates for more targeted radiation therapy techniques, most commonly of stereotactic radiosurgery (SRS), or surgical resection has evolved as randomized trials have shown that despite improved rates of intracranial disease control, adjunctive WBRT does not improve overall survival and may decrease quality of life due to side effects such as neurocognitive decline.

• #12 Brain Metastasis Treatment & Management: Medical Care, Surgical Care

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

  Medical treatment directed at cancer cells that have seeded into the brain is ineffective. […] A variety of chemotherapeutic agents have been used to treat brain metastasis from lung, breast, and melanoma, including cisplatin, cyclophosphamide, etoposide, teniposide, mitomycin, irinotecan, vinorelbine, etoposide, ifosfamide, temozolomide, fluorouracil (5FU), and prednisone. […] In most cases, 2-3 of these agents are used in combination and in conjunction with whole-brain radiation therapy (WBRT). […] The advent in small-molecule tyrosine kinase inhibitors (tyrKi) and monoclonal antibodies has helped transform the management of brain metastasis. […] Radiation therapy has become a mainstream therapy for brain metastasis. […] For decades, WBRT has been advocated for patients with multiple lesions.

• #13 Treatment of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5087313/

  The most appropriate definitive therapy is selected based on the number, size, and location of BM; the primary tumor type; extent and control of systemic disease; and a patient’s performance status. […] Currently, systemic therapy is not used routinely to treat BM. However, it may be the first therapeutic choice for BM from highly chemotherapy-sensitive primary tumors, such as germ cell tumors and small-cell lung carcinomas. […] WBRT is the most frequently used treatment for multiple BM and improves neurologic symptoms and median survival, from 1 to 2 months without WBRT to 3 to 6 months with it. […] SRS has also been studied as salvage therapy. […] In conclusion, BMs are common, and their frequency is increasing. Current care involves radiotherapy, either SRS or WBRT, and/or surgery and depends on the number, size, and site of metastases, as well as overall systemic disease control and a patient’s performance status. Systemic chemotherapeutic approaches are gaining traction and are increasingly efficacious options that are being used earlier in the course of the illness. Early vigorous treatment can enhance a patient’s functional status and prolong CNS disease control and survival. Better understanding of the interactions between BM, the microenvironment, and the BBB may identify novel targets to prevent and treat BM. […] This further supports the use of SRS alone with close monitoring as up-front therapy for patients with newly diagnosed brain metastases.

• #14 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  During stereotactic radiation therapy, many beams of radiation are aimed at the tumor cells. Each beam isn’t that powerful, but the point where all the beams meet receives a very large dose of radiation to kill tumor cells. […] Treatment may include one or both of the following: Whole-brain radiation. Whole-brain radiation aims beams at the entire brain to kill tumor cells. People having whole-brain radiation usually need 10 to 15 treatments over 2 to 3 weeks. […] Stereotactic radiosurgery is a focused radiation treatment. It also is called SRS or stereotactic body radiotherapy. SRS aims beams of radiation from many angles at the cancer. […] Healthcare professionals have made major advances understanding whole-brain radiation and stereotactic radiosurgery. They have learned how these therapies affect survival, brain function and quality of life. In deciding which radiation therapy to have, you and your healthcare professional will consider many factors. These include the number of brain metastases present, other treatments you’re getting and how likely your cancer is to recur.

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

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

  Metastatic brain tumor (brain metastases) happens when cancer in one part of your body spreads to your brain. Healthcare providers treat brain metastases with surgery and radiation therapy. They may combine surgery with other treatments to minimize the brain tumors impact and help you maintain your quality of life. […] Treatment for metastatic brain tumors aims to stop or slow the tumors growth in your brain while reducing your symptoms. Treatments include: Medications to manage symptoms. Radiation therapy and surgery. Cancer medications. […] The most common treatments for brain metastases remove all or part of the tumor/s: Stereotactic radiosurgery/Gamma Knife radiosurgery. This is the most common way healthcare providers in the United States treat brain metastases. Providers target brain tumors with high doses of radiation while the rest of your head and brain get very little radiation. Stereotactic radiosurgery usually involves a single treatment session. Whole brain radiation therapy. Your healthcare provider may use this treatment if you have several brain tumors or if the cancer has spread to your brains membranes. This is called leptomeningeal disease. Treatment typically involves 10 to 15 sessions spread out over two or three weeks. Brain surgery. Your provider may use traditional surgery to remove the tumor(s).

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

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

  Metastatic brain tumor (brain metastases) happens when cancer in one part of your body spreads to your brain. Healthcare providers treat brain metastases with surgery and radiation therapy. They may combine surgery with other treatments to minimize the brain tumors impact and help you maintain your quality of life. […] Treatment for metastatic brain tumors aims to stop or slow the tumors growth in your brain while reducing your symptoms. Treatments include: Medications to manage symptoms. Radiation therapy and surgery. Cancer medications. […] The most common treatments for brain metastases remove all or part of the tumor/s: Stereotactic radiosurgery/Gamma Knife radiosurgery. This is the most common way healthcare providers in the United States treat brain metastases. Providers target brain tumors with high doses of radiation while the rest of your head and brain get very little radiation. Stereotactic radiosurgery usually involves a single treatment session. Whole brain radiation therapy. Your healthcare provider may use this treatment if you have several brain tumors or if the cancer has spread to your brains membranes. This is called leptomeningeal disease. Treatment typically involves 10 to 15 sessions spread out over two or three weeks. Brain surgery. Your provider may use traditional surgery to remove the tumor(s).

• #17 Treatment for secondary brain cancer | Cancer Research UK

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

  Treatment for secondary brain cancer aims to control the cancer and your symptoms. It can also prevent problems from developing. […] You are likely to have a combination of treatments. Some to control the cancer and others to control specific symptoms. […] Radiotherapy treatment uses high energy x-rays to kill cancer cells. Radiotherapy can help to control cancer growth and symptoms. […] Stereotactic radiotherapy (SRT) is one type of external radiotherapy. It’s a targeted treatment and gives radiotherapy from many different angles around the body. […] For some people with secondary brain cancer, you might be able to have the full dose of radiotherapy as a single fraction. This is also called stereotactic radiosurgery. […] For several areas of secondary brain cancer (multiple brain metastases), you might have whole brain radiotherapy.

• #18 Tailored Radiation for Brain Metastases Reduces Cognitive Impact – NCI

  https://www.cancer.gov/news-events/cancer-currents-blog/2018/brain-metastases-radiation-therapy-hippocampal-avoidance

  The results confirm earlier studies that had suggested the hippocampus is highly sensitive to radiation, he said. They also verify that, by sparing the hippocampus, we can achieve the objectives of protecting patients cognitive function, effectively managing their brain metastases, and improving neurological symptoms. […] Christina Tsien, M.D., of the Washington University School of Medicine in St. Louis, speaking at the ASTRO meeting, said that hippocampal-avoidance WBRT now represents a standard of care for patients with brain metastases. […] Based on these studies, researchers with the NCI-sponsored NRG Oncology clinical trials group decided to test whether tailored WBRT that avoids the hippocampus could help limit treatment-related cognitive decline. […] Overall, patients who underwent hippocampal avoidance had a 26% reduced risk of experiencing cognitive decline.

• #19 Management of Lung Cancer Brain Metastases: An Update | Consult QD

  https://consultqd.clevelandclinic.org/management-of-lung-cancer-brain-metastases-an-update

  We now have an expanded toolbox to extend survival and lessen treatment toxicity. The safe and effective management of lung cancer brain metastases is coming to the fore. The goals we always keep in mind in these cases are to extend survival, prevent neurological dysfunction and improve quality of life. In most cases, adding whole brain radiation therapy (WBRT) or stereotactic radiosurgery to surgery has been essential to increase survival and reduce tumor recurrences. Most importantly, WBRT is associated with neurocognitive decline, which becomes more evident as patients live longer than one year. This risk can be lowered by newer approaches such as medications (e.g., memantine) or modified radiation delivery such as hippocampal sparing during WBRT; however, delayed impact on cognition continues to be a factor. WBRT is still considered necessary for leptomeningeal disease and for cases involving numerous metastatic lesions, although the threshold is not well defined and is rising as other therapies prove effective for multiple metastases. Stereotactic radiosurgery offers multiple advantages over many other therapies, including lower cost and, in most cases, avoidance of general anesthesia for surgery. It also can be used as salvage treatment for recurrence of metastases following WBRT. Comparable to WBRT in terms of overall survival and local and distant control, it allows faster time to systemic therapy and causes fewer toxicities, including neurocognitive impairment. For large brain metastases ( 2 cm), single-session radiosurgery does not consistently provide durable control. Instead, we recommend staged treatment i.e., two stereotactic radiosurgery treatments performed one month apart effectively boosting the target and achieving approximately 90% one-year local control. In recent years, we have changed how we treat non-small cell lung cancer (NSCLC) tumors driven by epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements, and this has had significant impact on control of lung cancer-related brain metastases. Since 2015, TKIs with CNS activity have become available and have quickly moved from second-line to frontline therapy. We now even have data supporting adjuvant use of one TKI, osimertinib, for EGFR-positive tumors. These developments have given us the welcome option of withholding WBRT in TKI-nave patients. In cases of EGFR or ALK-driven tumors with brain metastases, virtually all patients who are TKI-nave receive TKI therapy plus stereotactic radiosurgery. Even as the field grapples with these questions, the progress of the past few years particularly the advent of systemic therapies and improvements in the use of stereotactic radiosurgery deserves recognition.

• #20 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  During stereotactic radiation therapy, many beams of radiation are aimed at the tumor cells. Each beam isn’t that powerful, but the point where all the beams meet receives a very large dose of radiation to kill tumor cells. […] Treatment may include one or both of the following: Whole-brain radiation. Whole-brain radiation aims beams at the entire brain to kill tumor cells. People having whole-brain radiation usually need 10 to 15 treatments over 2 to 3 weeks. […] Stereotactic radiosurgery is a focused radiation treatment. It also is called SRS or stereotactic body radiotherapy. SRS aims beams of radiation from many angles at the cancer. […] Healthcare professionals have made major advances understanding whole-brain radiation and stereotactic radiosurgery. They have learned how these therapies affect survival, brain function and quality of life. In deciding which radiation therapy to have, you and your healthcare professional will consider many factors. These include the number of brain metastases present, other treatments you’re getting and how likely your cancer is to recur.

• #21 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  During stereotactic radiation therapy, many beams of radiation are aimed at the tumor cells. Each beam isn’t that powerful, but the point where all the beams meet receives a very large dose of radiation to kill tumor cells. […] Treatment may include one or both of the following: Whole-brain radiation. Whole-brain radiation aims beams at the entire brain to kill tumor cells. People having whole-brain radiation usually need 10 to 15 treatments over 2 to 3 weeks. […] Stereotactic radiosurgery is a focused radiation treatment. It also is called SRS or stereotactic body radiotherapy. SRS aims beams of radiation from many angles at the cancer. […] Healthcare professionals have made major advances understanding whole-brain radiation and stereotactic radiosurgery. They have learned how these therapies affect survival, brain function and quality of life. In deciding which radiation therapy to have, you and your healthcare professional will consider many factors. These include the number of brain metastases present, other treatments you’re getting and how likely your cancer is to recur.

• #22 Treatment of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5087313/

  Brain metastases (BMs) occur in 10% to 20% of adult patients with cancer, and with increased surveillance and improved systemic control, the incidence is likely to grow. Despite multimodal treatment, prognosis remains poor. Current evidence supports use of whole-brain radiation therapy when patients present with multiple BMs. However, its associated cognitive impairment is a major deterrent in patients likely to live longer than 6 months. […] In patients with oligometastases (one to three metastases) and even some with multiple lesions less than 3 to 4 cm, especially if the primary tumor is considered radiotherapy resistant, stereotactic radiosurgery is recommended; if the BMs are greater than 4 cm, surgical resection with or without postoperative whole-brain radiation therapy should be considered.

• #23 Guidelines for the Treatment of Adults with Metastatic Brain Tumors

  https://www.cns.org/guidelines/browse-guidelines-detail/treatment-options-adults-with-multiple-metastatic-

  Target population: These recommendations apply to adult patients newly diagnosed with multiple (more than one) brain metastases. […] It is recommended that whole brain radiation therapy can be added to stereotactic radiosurgery to improve local and distant control, keeping in mind the potential for worsened neurocognitive outcomes and that there is unlikely to be a significant impact on overall survival. […] In patients with 2 to 3 brain metastases not amenable to surgery, the addition of stereotactic radiosurgery to whole brain radiation therapy is not recommended to improve survival beyond that obtained with whole brain radiation therapy alone. […] The use of stereotactic radiosurgery alone is recommended to improve median overall survival for patients with more than 4 metastases having a cumulative volume 7 cc.

• #24 Brain Metastases Treatment – Brainlab.org

  https://www.brainlab.org/brain-metastases-treatment/

  Over the last decade, studies have been conducted that suggest that some patients can be treated with stereotactic radiosurgery (SRS) alone without whole brain radiation therapy. […] The development of the micro-multileaf collimator has been the biggest advance in radiosurgery during my professional career it allows more precise and homogenous deliver of the radiation to the target only, so youre delivering a minimum of radiation to the healthy brain tissue around it. […] We now have capabilities, in radiosurgery, to treat tumors that are in deep and inaccessible areas with almost relative impunity. […] The future of brain metastasis treatments? Better neuroimaging, better technologies to deliver radiation specifically radiosurgery and better systemic agents that will cross the blood-brain barrier, hone in and target tumors. […] Newer evidence shows that if we use stereotactic radiosurgery for up to 10 brain metastases then we can get improved outcomes in terms of the quality of life for that patient.

• #25 Types of Radiation Therapy Used to Treat Metastasis to the Brain – Brainlab.org

  https://www.brainlab.org/get-educated/brain-metastasis/understand-radiation-therapy-for-brain-metastasis/types-of-radiation-therapy-used-to-treat-metastasis-to-the-brain/

  Radiation therapy, also called radiotherapy, is a common cancer treatment for brain metastases. […] If your cancer care team recommends radiation therapy to treat your brain metastases, you will want to explore the different types available and understand the pros and cons of each therapy. […] The conventional radiation therapy method for brain metastases, whole brain radiotherapy, has been in use since 1954 even though there is a risk of short- and long-term side effects. […] WBRT is just what it sounds like giving radiation to the entire brain, even to healthy tissue. […] Another form of radiation therapy, stereotactic radiosurgery (SRS) is often called knifeless surgery due to the ability to precisely target cancer cells while sparing healthy surrounding brain tissue. […] Stereotactic radiosurgery is an advanced and targeted radiation delivery technique.

• #26 Tailored Radiation for Brain Metastases Reduces Cognitive Impact – NCI

  https://www.cancer.gov/news-events/cancer-currents-blog/2018/brain-metastases-radiation-therapy-hippocampal-avoidance

  Radiation therapy, a widely used treatment for brain metastases, can impair important brain functions like memory, processing speed, and attention span, often greatly affecting patients quality of life. Initial results from a large clinical trial now suggest that an advanced radiotherapy technique can limit the harm to patients cognitive function compared to standard radiation therapy without affecting the treatments ability to shrink or control brain tumors. […] Compared with patients who received standard WBRT, those who underwent hippocampal-avoidance WBRT were less likely to experience declines in cognitive function, said the trials co-lead investigator, Vinai Gondi, M.D., director of research at the Northwestern Medicine Proton Center and the Northwestern Medicine Cancer Center Warrenville.

• #27 What Are the Current Options for Patients with Brain Metastases, including Surgery, SRS, WBRT, and Drugs? | Alliance Cancer Care

  https://alliancecancercare.com/news/what-are-the-current-options-for-patients-with-brain-metastases-including-surgery-srs-wbrt-and-drugs/

  Another advantage of SRS over WBRT is fewer treatments (1-5 versus 10-15), which is more convenient for the patient and less likely to delay important systemic therapies. […] When is SRS not a good option for brain mets? […] If your radiation oncologist tells you they recommend whole brain radiation, it is not something to be frightened about as a patient. […] The other great news is we have new tools demonstrated in randomized trials to minimize the risk of cognitive/memory issues after WBRT. […] A final thing to mention is the potential role of systemic therapy for patients with brain mets. […] In closing, patients with stage IV (metastatic) cancer are living longer due to better systemic therapies. This means more of them are alive long enough to develop brain mets. Fortunately, we have many tools to address a patients brain mets. Techniques such as SRS or hippocampal-sparing WBRT are excellent ways of treating brain mets in ways that maximize our ability to limit the risk of long-term cognitive and quality of life issues.

• #28 Brain Metastasis Treatment & Management: Medical Care, Surgical Care

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

  Hippocampal avoidance (HA), a modification of WBRT, may preserve short-term memory in cancer patients with brain metastases. […] Stereotactic radiosurgery (SRS) is a more preferred treatment modality for radio-resistant lesions such as nonsmall cell lung cancer, renal cell carcinoma, and melanoma. […] Surgical resection is considered standard care for solitary metastases larger than 3 cm and in noneloquent areas of the brain. […] Surgical resection is superior to radiosurgery, with a median survival nearly twice that of radiosurgery. […] In 2 prospective randomized trials, surgical resection plus WBRT was more effective than WBRT alone in controlling disease. […] Surgery in combination of WBRT is the most common mode of therapy. […] The local recurrence rate of brain metastasis is relatively high.

• #29 Treatment strategies for breast cancer brain metastases | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01175-y

  Current therapeutic options for patients with BCBM include surgical resection, stereotactic radiosurgery (SRS), whole-brain radiation therapy (WBRT), chemotherapy and targeted therapy. […] Nevertheless, this concept has been challenged as the results from some clinical trials indicate that systemic therapies can be effective for the treatment of BM, as discussed in this paper. […] The use of surgery is most often reserved for patients with good performance status, few lesions or large symptomatic lesions (3cm). Surgery followed by radiation therapy has been shown to improve OS and symptom control vs radiation therapy alone. […] When surgical resection is not feasible, SRS alone is the recommended approach. […] The use of WBRT alone is indicated only in patients with more than ten BM for whom local treatment is not appropriate and in patients with new lesions on which additional SRS cannot be performed.

• #30 Brain Metastases Treatment | UVA Health

  https://uvahealth.com/services/brain-cancer-treatment/brain-metastases

  Taking out the tumors can relieve pressure on your brain and lessen your symptoms. Our surgeons are experts in operating on this critical part of the body. […] Through clinical trials, we bring you treatments you can’t find anywhere else. Our research improves and prolongs patients’ lives. We’ll help you find clinical trials that can help you.

• #31 Guidelines for the Treatment of Adults with Metastatic Brain Tumors

  https://www.cns.org/guidelines/browse-guidelines-detail/treatment-options-adults-with-multiple-metastatic-

  In patients with multiple brain metastases, tumor resection is recommended in patients with lesions inducing symptoms from mass effect that can be reached without inducing new neurologic deficit and who have control of their cancer outside the nervous system. […] Treatment of brain metastases needs to be individualized while relying as much as possible on evidence-based guidelines. […] The goal of treatment of a patient with brain metastases, either single or multiple, is that of palliating and/or preventing neurologic symptoms, while also maintaining a good quality of life. […] Class III data shows that for 2 to 4 metastases SRS can be used instead of WBRT depending on tumor volume, location, and histology and on patient functional status. […] Class II data suggest that WBRT can be added in cases of multiple metastases to improve local and distant central nervous system control but may have an adverse effect on neurocognitive function and is unlikely to improve overall survival.

• #32

• #33 Management of Brain Metastases

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

  Radiation therapy has been the mainstay of treatment for patients with brain metastases for nearly 40 years. Overall, conventional whole-brain radiation therapy increases median survival to 3 to 6 months. Radiation is effective in the palliation of neurologic symptoms and also significantly decreases the likelihood of death due to neurologic causes. […] The introduction of radiosurgery over the past decade represents one of the major advances in the treatment of brain metastases. Young patients with good performance status, limited extracranial disease, and one or two small lesions are particularly suited to this form of treatment. […] Overall, these studies provide support for the use of surgery in addition to whole-brain radiation in patients with a single brain metastasis and stable extracranial disease.

• #34 Brain Metastases: Staging and Treatment | OncoLink

  https://www.oncolink.org/cancers/brain-tumors/brain-metastasis/brain-metastases-staging-and-treatment

  Treatment for brain mets depends on many factors, like your primary cancer stage and what treatments you are getting, your age, overall health, and number of brain mets. Your treatment may include some or all of the following: […] Each primary cancer acts and is treated differently. The treatment options for brain mets depend on your primary tumor type. […] Surgery can be used to treat one met (lesion), especially if the cancer is under control in the rest of your body. The lesion must be in an area of the brain where it is safe to have surgery. Studies have shown that patients with a single brain metastasis who had surgery followed by whole brain radiation therapy (WBRT) have fewer recurrences (when the cancer comes back) and better quality of life than patients treated with WBRT alone.

• #35 Metastatic Brain Tumor Treatment & Surgery | Pacific Brain Tumor Center

  https://www.pacificneuroscienceinstitute.org/brain-tumor/conditions/metastatic-brain-tumors/

  An additional goal is to obtain tumor tissue for histological subtyping and genetic profiling for novel targeted therapies options and clinical trials, which are increasingly available for patients with metastatic brain tumors. […] For larger symptomatic brain metastases over 2-3 cm in diameter with associated brain swelling, surgical removal through a Keyhole Craniotomy is often indicated. […] In other patients with one or more smaller tumors, particularly those that are not easily accessible by surgery, precision radiosurgery (SRS) is typically used. […] Coordinating these brain-directed treatments with treatment of the cancer elsewhere in the body is essential to gaining control of the cancer. […] Fortunately, with advances in tumor genetic profiling, novel chemo- and immunotherapies and related clinical trials are available for many of our patients. […] One key purpose of metastasis removal is obtaining tissue for genetic profiling agents and there are always new therapies in development.

• #36 Metastatic Brain Tumor Treatment & Surgery | Pacific Brain Tumor Center

  https://www.pacificneuroscienceinstitute.org/brain-tumor/conditions/metastatic-brain-tumors/

  Minimally invasive surgery precision radiosurgery are often essential first steps in treating Metastatic brain tumors […] Optimal personalized treatment of patients with metastatic brain tumors requires a team approach of medical and neuro-oncologists, radiation oncologists and neurosurgeons, as well as cutting-edge brain imaging and tumor genetic profiling. Treatment of the cancer in the body, needs to be coordinated with brain-directed therapies in a targeted and precise fashion. […] The initial treatment of metastatic brain tumors is typically focused radiation (radiosurgery) and/or surgical removal depending upon the type, size, location and number of metastases. […] Fortunately, for patients who require metastatic brain tumor surgery, most can be removed through a minimally invasive keyhole approach.

• #37 6 Innovative Brain Metastases Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/brain-metastases/brain-metastases-treatment.html

  However, recent research has shown several promising chemotherapies may play an important role in treating some brain metastases. […] Laser interstitial thermal therapy (LITT) is performed by inserting a laser probe into the tumor and heating it to temperatures high enough to destroy the tumor. […] Immunotherapy uses the bodys own immune system to fight cancer. These treatments are relatively new and are proving effective in treating melanoma brain metastases, but are still being studied in other tumor types. […] Targeted therapies target the specific gene mutations that cause cancer. Several of these drugs are under investigation in clinical trials for patients with specific types of cancer.

• #38 Brain Metastases Treatment | UVA Health

  https://uvahealth.com/services/brain-cancer-treatment/brain-metastases

  Treating brain metastases is different from treating other types of cancer. For example, many chemotherapy drugs don’t work for brain cancer. That’s because they can’t cross the blood-brain barrier. This filter stops medicines from reaching your brain. […] Determining the right treatment for someone with brain metastases can be very difficult. It can include decisions about extending life and making sure you have good quality of life. We understand these decisions are very personal. We want to help you find the right treatment for you. […] Some treatments can help you live longer, but won’t help you have good quality of life during that extra time. And some treatments, like whole-brain radiation therapy, relieve symptoms. But then the treatment causes neurological problems. […] Brain metastases can’t be cured. But at UVA Health, we’ll help you choose treatments that give you the most time with the highest quality of life.

• #39 Brain Metastases | Cancer Spread to Brain | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/advanced-cancer/brain-metastases.html

  Chemotherapy is not usually a treatment for brain metastases because these medicines have a hard time getting into the brain. However, for people with meningitis from cancer, chemotherapy may be injected right into the fluid that surrounds the brain and spinal cord. This can be done during a lumbar puncture (needle into the back) or through a device called an Ommaya reservoir. […] For a few types of cancer, there are new medicines that can get into the brain when given into a vein. Your cancer care team will let you know if this treatment is an option for you.

• #40 Treatment strategies for breast cancer brain metastases | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01175-y

  For systemic therapies, various drugs, including older chemotherapy agents such as capecitabine, cyclophosphamide, 5-fluorouracil, methotrexate, vincristine, cisplatin, etoposide, vinorelbine and gemcitabine, have shown activity in the treatment of BM, with an objective response rate (ORR) of over 30%. […] New chemotherapy agents, such as third-generation taxanes, are in development for the specific indication of BCBM. […] To date, evidence for the direct efficacy of HER2-targeting monoclonal antibodies trastuzumab, trastuzumab-emtansine (T-DM1) and pertuzumab on BMBC is based on the retrospective subgroup analysis of clinical trials or on small cohorts. […] These studies show a correlation between the use of trastuzumab and the development of less aggressive BM. […] The best results published to date have been obtained in patients with BM from HER2+ MBC, for whom all currently used combinations of chemotherapy and anti-HER2 therapy have shown some efficacy, with particularly impressive results obtained with the tucatinib-trastuzumab-capecitabine combination. […] The individuality of patients with BCBM, in terms of clinical characteristics and treatment resistance, makes it necessary to develop specific clinical trials to generate new treatment strategies.

• #41 Treatment strategies for breast cancer brain metastases | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01175-y

  For systemic therapies, various drugs, including older chemotherapy agents such as capecitabine, cyclophosphamide, 5-fluorouracil, methotrexate, vincristine, cisplatin, etoposide, vinorelbine and gemcitabine, have shown activity in the treatment of BM, with an objective response rate (ORR) of over 30%. […] New chemotherapy agents, such as third-generation taxanes, are in development for the specific indication of BCBM. […] To date, evidence for the direct efficacy of HER2-targeting monoclonal antibodies trastuzumab, trastuzumab-emtansine (T-DM1) and pertuzumab on BMBC is based on the retrospective subgroup analysis of clinical trials or on small cohorts. […] These studies show a correlation between the use of trastuzumab and the development of less aggressive BM. […] The best results published to date have been obtained in patients with BM from HER2+ MBC, for whom all currently used combinations of chemotherapy and anti-HER2 therapy have shown some efficacy, with particularly impressive results obtained with the tucatinib-trastuzumab-capecitabine combination. […] The individuality of patients with BCBM, in terms of clinical characteristics and treatment resistance, makes it necessary to develop specific clinical trials to generate new treatment strategies.

• #42 Treatment strategies for breast cancer brain metastases | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01175-y

  For systemic therapies, various drugs, including older chemotherapy agents such as capecitabine, cyclophosphamide, 5-fluorouracil, methotrexate, vincristine, cisplatin, etoposide, vinorelbine and gemcitabine, have shown activity in the treatment of BM, with an objective response rate (ORR) of over 30%. […] New chemotherapy agents, such as third-generation taxanes, are in development for the specific indication of BCBM. […] To date, evidence for the direct efficacy of HER2-targeting monoclonal antibodies trastuzumab, trastuzumab-emtansine (T-DM1) and pertuzumab on BMBC is based on the retrospective subgroup analysis of clinical trials or on small cohorts. […] These studies show a correlation between the use of trastuzumab and the development of less aggressive BM. […] The best results published to date have been obtained in patients with BM from HER2+ MBC, for whom all currently used combinations of chemotherapy and anti-HER2 therapy have shown some efficacy, with particularly impressive results obtained with the tucatinib-trastuzumab-capecitabine combination. […] The individuality of patients with BCBM, in terms of clinical characteristics and treatment resistance, makes it necessary to develop specific clinical trials to generate new treatment strategies.

• #43 Brain Metastases – AIM at Melanoma Foundation

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

  There are multiple FDA-approved targeted therapies for patients with metastatic melanoma with a BRAF mutation in their tumor. […] Drugs such as Temodar and Fotemustine are able to get into the brain tissue and may be used to treat patients with brain metastases. […] Supportive care is used when the physician feels that active treatment will do more harm than good, or if it is the patient’s preference not to be treated.

• #44 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

  Leptomeningeal disease (LMD) may be treated with targeted therapy pills or chemotherapy either injected through the arm, directly into the spinal fluid or through a device inserted under your scalp called an Ommaya reservoir. […] Proton therapy is a particular type of radiation originally developed for pediatric brain tumors that helps reduce long term side effects in children. […] Focused radiation has few side effects as it is mostly killing tumor cells and not many normal cells. […] Whole brain radiation therapy (WBRT) can cause fatigue in the short term and aging of the brain, including radiation dementia in the long term. […] It is possible to live well after brain radiation. The best things you can do are to try and keep your brain active with activities like reading, puzzles and conversations and to stay in close contact with your doctor about any side effects that you are experiencing.

• #45 Brain Metastases: Staging and Treatment | OncoLink

  https://www.oncolink.org/cancers/brain-tumors/brain-metastasis/brain-metastases-staging-and-treatment

  Whole brain radiotherapy (WBRT) is radiation given to the entire brain. WBRT improves symptoms of brain metastases in 70-90% of patients, although some of this is also a result of the corticosteroids. Recurrence is common, and control of brain metastases may only happen in half of the patients. […] Stereotactic radiosurgery (SRS) is not surgery. It is a large dose of radiation to the tumor given in a very precise way. […] Chemotherapy is the use of anti-cancer medications to treat cancer. It is believed that most chemotherapy medications are not able to enter the brain. […] These therapies target specific changes on a cell that help cancer grow and spread. Your tumor will be tested for these specific targets. […] Immunotherapy uses your body’s own immune system to find and kill cancer cells. […] You may be offered a clinical trial as part of your treatment plan.

• #46 Brain Metastases Treatment Approach | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/treatment/neuro-oncology/programs/brain-metastases/approach

  Systemic treatment options for patients with brain metastases can be quite different depending on the types of treatment(s) you have previously received, the underlying type of cancer, the genetic/molecular characteristics of the cancer, and your overall health. […] Dana-Farber Brigham Cancer Center researchers have been on the forefront of developing new systemic treatment options for brain metastases. […] Clinical trials are research studies that evaluate the safety and effectiveness of new treatments, such as new systemic therapies, surgical techniques, or radiation treatments. […] Dana-Farber Brigham Cancer Center offers an extensive number of clinical trials for patients with brain metastases, including those appropriate for recurrent disease, or even as a first treatment before surgery or radiation therapy.

• #47 Emerging Treatments for Brain Metastases in Breast Cancer | Cancer Today

  https://www.cancertodaymag.org/cancer-talk/emerging-treatments-for-brain-metastases-in-breast-cancer/

  But management of brain metastases has evolved in what Dent called a watershed moment as researchers discover systemic therapies that penetrate the blood-brain barrier and ward off tumor progression. […] Tukysa, in combination with trastuzumab and capecitabine, was approved in April 2020 for patients with metastatic breast cancer who had already undergone one or more HER2-based treatment regimens. […] This trial really showcased that we saw this tremendous intracranial response in improvement in PFS [progression-free survival]. […] The first ADC for brain metastases, Kadcyla (trastuzumab emtansine) was approved in 2013after showing it could increase median progression-free survival and overall survival in patients with metastatic HER2-positive breast cancer. […] Data also supported its efficacy for treating brain metastases.

• #48 Emerging Treatments for Brain Metastases in Breast Cancer | Cancer Today

  https://www.cancertodaymag.org/cancer-talk/emerging-treatments-for-brain-metastases-in-breast-cancer/

  But management of brain metastases has evolved in what Dent called a watershed moment as researchers discover systemic therapies that penetrate the blood-brain barrier and ward off tumor progression. […] Tukysa, in combination with trastuzumab and capecitabine, was approved in April 2020 for patients with metastatic breast cancer who had already undergone one or more HER2-based treatment regimens. […] This trial really showcased that we saw this tremendous intracranial response in improvement in PFS [progression-free survival]. […] The first ADC for brain metastases, Kadcyla (trastuzumab emtansine) was approved in 2013after showing it could increase median progression-free survival and overall survival in patients with metastatic HER2-positive breast cancer. […] Data also supported its efficacy for treating brain metastases.

• #49 Management of Lung Cancer Brain Metastases: An Update | Consult QD

  https://consultqd.clevelandclinic.org/management-of-lung-cancer-brain-metastases-an-update

  We now have an expanded toolbox to extend survival and lessen treatment toxicity. The safe and effective management of lung cancer brain metastases is coming to the fore. The goals we always keep in mind in these cases are to extend survival, prevent neurological dysfunction and improve quality of life. In most cases, adding whole brain radiation therapy (WBRT) or stereotactic radiosurgery to surgery has been essential to increase survival and reduce tumor recurrences. Most importantly, WBRT is associated with neurocognitive decline, which becomes more evident as patients live longer than one year. This risk can be lowered by newer approaches such as medications (e.g., memantine) or modified radiation delivery such as hippocampal sparing during WBRT; however, delayed impact on cognition continues to be a factor. WBRT is still considered necessary for leptomeningeal disease and for cases involving numerous metastatic lesions, although the threshold is not well defined and is rising as other therapies prove effective for multiple metastases. Stereotactic radiosurgery offers multiple advantages over many other therapies, including lower cost and, in most cases, avoidance of general anesthesia for surgery. It also can be used as salvage treatment for recurrence of metastases following WBRT. Comparable to WBRT in terms of overall survival and local and distant control, it allows faster time to systemic therapy and causes fewer toxicities, including neurocognitive impairment. For large brain metastases ( 2 cm), single-session radiosurgery does not consistently provide durable control. Instead, we recommend staged treatment i.e., two stereotactic radiosurgery treatments performed one month apart effectively boosting the target and achieving approximately 90% one-year local control. In recent years, we have changed how we treat non-small cell lung cancer (NSCLC) tumors driven by epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements, and this has had significant impact on control of lung cancer-related brain metastases. Since 2015, TKIs with CNS activity have become available and have quickly moved from second-line to frontline therapy. We now even have data supporting adjuvant use of one TKI, osimertinib, for EGFR-positive tumors. These developments have given us the welcome option of withholding WBRT in TKI-nave patients. In cases of EGFR or ALK-driven tumors with brain metastases, virtually all patients who are TKI-nave receive TKI therapy plus stereotactic radiosurgery. Even as the field grapples with these questions, the progress of the past few years particularly the advent of systemic therapies and improvements in the use of stereotactic radiosurgery deserves recognition.

• #50 6 Innovative Brain Metastases Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/brain-metastases/brain-metastases-treatment.html

  However, recent research has shown several promising chemotherapies may play an important role in treating some brain metastases. […] Laser interstitial thermal therapy (LITT) is performed by inserting a laser probe into the tumor and heating it to temperatures high enough to destroy the tumor. […] Immunotherapy uses the bodys own immune system to fight cancer. These treatments are relatively new and are proving effective in treating melanoma brain metastases, but are still being studied in other tumor types. […] Targeted therapies target the specific gene mutations that cause cancer. Several of these drugs are under investigation in clinical trials for patients with specific types of cancer.

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

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

  Your provider may recommend drug treatments in addition to surgery or radiation depending on your primary cancer type: Chemotherapy: Most chemotherapy drugs dont work on brain metastases because they cant pierce the blood-brain barrier. This barrier keeps certain substances (like chemo drugs) in your blood from reaching your brain. But providers may inject chemo directly into the fluid surrounding your brain if the metastases have spread there. Targeted therapy: These drugs interfere with processes that cancer cells use to multiply. Research shows that targeted therapy may work on some types of lung and breast cancers that have spread to the brain. Immunotherapy: Immunotherapy drugs help your immune system find and destroy cancer cells. They help treat some lung cancer and melanoma brain metastases.

• #52 Brain Metastases – AIM at Melanoma Foundation

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

  Surgery is a standard treatment for melanoma brain metastases. It is potentially curative for patients whose melanoma is otherwise controlled and who have a limited number of brain metastases. […] Stereotactic radiosurgery (SRS) targets certain spots in the brain. […] Whole-brain radiation treatment (WBRT) treats brain metastases that can be seen, as well as tumor cells that are too small to be identified by MRI or CT scans. […] Brain metastases can cause swelling in the brain which can result in a variety of symptoms, including headache, nausea, vomiting, and/or confusion. Steroids can reduce swelling in the brain and, therefore, are often used to treat the symptoms caused by brain metastases. […] Most FDA-approved checkpoint inhibitor-based immunotherapies can achieve significant shrinkage of melanoma brain metastases.

• #53 MD Anderson’s Brain Metastases Clinic offers treatment options for secondary brain tumors | MD Anderson Cancer Center

  https://www.mdanderson.org/publications/annual-report/annual-report-2019/new-clinic-expands-brain-metastasis-treatment-options.html

  Tawbi subsequently led a clinical trial of two drugs that, when used together, train the immune system to attack cancer. […] These and other clinical trials have persuaded some pharmaceutical companies to begin designing drugs against brain metastases, and the FDA has indicated it will require an explanation for excluding these patients from clinical trials. […] Fourteen open clinical trials are associated with MD Andersons Brain Metastases Clinic. Together, theyre testing a variety of drugs in combination with other therapies. […] But soon, Tawbi says, the clinic hopes to offer clinical trials that will be open to all patients with brain metastases, regardless of where their primary tumor started.

• #54 Emerging Treatments for Brain Metastases in Breast Cancer | Cancer Today

  https://www.cancertodaymag.org/cancer-talk/emerging-treatments-for-brain-metastases-in-breast-cancer/

  But management of brain metastases has evolved in what Dent called a watershed moment as researchers discover systemic therapies that penetrate the blood-brain barrier and ward off tumor progression. […] Tukysa, in combination with trastuzumab and capecitabine, was approved in April 2020 for patients with metastatic breast cancer who had already undergone one or more HER2-based treatment regimens. […] This trial really showcased that we saw this tremendous intracranial response in improvement in PFS [progression-free survival]. […] The first ADC for brain metastases, Kadcyla (trastuzumab emtansine) was approved in 2013after showing it could increase median progression-free survival and overall survival in patients with metastatic HER2-positive breast cancer. […] Data also supported its efficacy for treating brain metastases.

• #55 Emerging Treatments for Brain Metastases in Breast Cancer | Cancer Today

  https://www.cancertodaymag.org/cancer-talk/emerging-treatments-for-brain-metastases-in-breast-cancer/

  But management of brain metastases has evolved in what Dent called a watershed moment as researchers discover systemic therapies that penetrate the blood-brain barrier and ward off tumor progression. […] Tukysa, in combination with trastuzumab and capecitabine, was approved in April 2020 for patients with metastatic breast cancer who had already undergone one or more HER2-based treatment regimens. […] This trial really showcased that we saw this tremendous intracranial response in improvement in PFS [progression-free survival]. […] The first ADC for brain metastases, Kadcyla (trastuzumab emtansine) was approved in 2013after showing it could increase median progression-free survival and overall survival in patients with metastatic HER2-positive breast cancer. […] Data also supported its efficacy for treating brain metastases.

• #56 Emerging Treatments for Brain Metastases in Breast Cancer | Cancer Today

  https://www.cancertodaymag.org/cancer-talk/emerging-treatments-for-brain-metastases-in-breast-cancer/

  But management of brain metastases has evolved in what Dent called a watershed moment as researchers discover systemic therapies that penetrate the blood-brain barrier and ward off tumor progression. […] Tukysa, in combination with trastuzumab and capecitabine, was approved in April 2020 for patients with metastatic breast cancer who had already undergone one or more HER2-based treatment regimens. […] This trial really showcased that we saw this tremendous intracranial response in improvement in PFS [progression-free survival]. […] The first ADC for brain metastases, Kadcyla (trastuzumab emtansine) was approved in 2013after showing it could increase median progression-free survival and overall survival in patients with metastatic HER2-positive breast cancer. […] Data also supported its efficacy for treating brain metastases.

• #57 Emerging Treatments for Brain Metastases in Breast Cancer | Cancer Today

  https://www.cancertodaymag.org/cancer-talk/emerging-treatments-for-brain-metastases-in-breast-cancer/

  Enhertu is the next generation of antibody-drug conjugates, Dent said, during the panel discussion. […] Another benefit is a high drug-to-antibody ratio, which allows more of the drug to enter the cancer cells. […] In another study, almost half of patients with brain metastases who were given Enhertu had a response in the brainand many had a sustained response, Dent added. […] Newer systemic therapies may ease these concernsas several studies show these treatments may also prevent metastases in the first place. […] When you add in the tucatinib [Tukysa], you are getting to more than two years where you dont see any CNS mets, which is why it is really exciting to see these agents move up to earliest line in our metastatic armamentarium but also in earlier breast cancer.

• #58 Treatment for Metastatic Brain Cancer | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/brain-tumors-metastatic/treatment

  To create your treatment plan, our experts assess the number and location of tumors and your overall health. We may recommend surgery, radiation, or a combination to treat your disease. Most brain metastases do not get better with chemotherapy, so we rarely recommend it. […] Before we recommend any treatment, you will talk with the care team at our Multidisciplinary Brain Metastasis Center. You will meet with a surgeon and radiation oncologist (a doctor who uses radiation to treat cancer). You may also see a medical oncologist (a doctor who uses drugs to treat cancer). These experts will evaluate you and find the best care plan for you. […] You may be able to join one of our clinical trials. These research studies explore new treatments for brain metastases. […] We will help you manage the side effects of treatment. Rehabilitation is an important part of your care. Physical and occupational therapy can help you get back to your daily activities and we also have a special program for speech and hearing problems.

• #59 Brain Metastases Treatment Approach | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/treatment/neuro-oncology/programs/brain-metastases/approach

  Program for Patients with Breast Cancer Brain Metastases specializes in the treatment of patients with breast cancer that has spread to the brain. Our multidisciplinary team of internationally recognized experts includes medical oncologists, radiation oncologists, neurosurgeons, neuro-oncologists, neuroradiologists, and pathologists, who work together to provide the highest level of care. […] When surgery is indicated, our cancer neurosurgeons use the most advanced technologies available to remove as much of the tumor as possible, while preserving the surrounding brain tissue. […] Radiation therapy is often a treatment option for patients with cancer which has spread to the brain, and for most patients, is very effective. […] Stereotactic radiosurgery (SRS) is a technique for delivering high-dose radiation very precisely to a specific region of the brain.

• #60 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  Treatment for brain metastases can help ease symptoms, slow tumor growth and extend life. Even with successful treatment, they may return. That’s why your healthcare professional will follow you closely. […] Treatments will depend on the type, size, number and location of tumors. Healthcare professionals also consider your symptoms, health and treatment goals. […] Medicines can help control symptoms of brain metastases and make you more comfortable. Options might include: Steroids. These high-dose medicines also are called corticosteroids. They may decrease swelling in the brain caused by brain metastases, helping to relieve symptoms. Anti-seizure drugs. These medicines may help control seizures if you have any. […] Surgery may be an option if a tumor is easily reachable and fits into your overall cancer care plan. The surgeon will remove as much tumor as possible. Surgery may help improve symptoms and help with diagnosis. It is combined with other treatments.

• #61 Treatment of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5087313/

  The most appropriate definitive therapy is selected based on the number, size, and location of BM; the primary tumor type; extent and control of systemic disease; and a patient’s performance status. […] Currently, systemic therapy is not used routinely to treat BM. However, it may be the first therapeutic choice for BM from highly chemotherapy-sensitive primary tumors, such as germ cell tumors and small-cell lung carcinomas. […] WBRT is the most frequently used treatment for multiple BM and improves neurologic symptoms and median survival, from 1 to 2 months without WBRT to 3 to 6 months with it. […] SRS has also been studied as salvage therapy. […] In conclusion, BMs are common, and their frequency is increasing. Current care involves radiotherapy, either SRS or WBRT, and/or surgery and depends on the number, size, and site of metastases, as well as overall systemic disease control and a patient’s performance status. Systemic chemotherapeutic approaches are gaining traction and are increasingly efficacious options that are being used earlier in the course of the illness. Early vigorous treatment can enhance a patient’s functional status and prolong CNS disease control and survival. Better understanding of the interactions between BM, the microenvironment, and the BBB may identify novel targets to prevent and treat BM. […] This further supports the use of SRS alone with close monitoring as up-front therapy for patients with newly diagnosed brain metastases.

• #62 Salvage Treatment for Progressive Brain Metastases in Breast Cancer

  https://www.mdpi.com/2072-6694/14/4/1096

  The choice of optimal methods should be carefully discussed within the multidisciplinary tumor board. […] Repeated local therapy may provide a significant benefit in intracranial progression-free survival and overall survival. However, it could lead to significant toxicity. […] The choice of treatment method must consider performance status, cancer burden, possible toxicity, and previously applied therapy. […] If local therapy is unfeasible, selected patients, especially those with human epidermal growth factor receptor 2-positive breast cancer, may benefit from systemic therapy. […] The benefit of WBRT is disputable. Systemic treatment may be an alternative option if local therapy is not feasible. […] The selection of methods depends on performance status, disease burden, comorbidities, a biological subtype of breast cancer, and previously used therapies.

• #63 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  Treatment for brain metastases can help ease symptoms, slow tumor growth and extend life. Even with successful treatment, they may return. That’s why your healthcare professional will follow you closely. […] Treatments will depend on the type, size, number and location of tumors. Healthcare professionals also consider your symptoms, health and treatment goals. […] Medicines can help control symptoms of brain metastases and make you more comfortable. Options might include: Steroids. These high-dose medicines also are called corticosteroids. They may decrease swelling in the brain caused by brain metastases, helping to relieve symptoms. Anti-seizure drugs. These medicines may help control seizures if you have any. […] Surgery may be an option if a tumor is easily reachable and fits into your overall cancer care plan. The surgeon will remove as much tumor as possible. Surgery may help improve symptoms and help with diagnosis. It is combined with other treatments.

• #64 Salvage Treatment for Progressive Brain Metastases in Breast Cancer

  https://www.mdpi.com/2072-6694/14/4/1096

  The choice of optimal methods should be carefully discussed within the multidisciplinary tumor board. […] Repeated local therapy may provide a significant benefit in intracranial progression-free survival and overall survival. However, it could lead to significant toxicity. […] The choice of treatment method must consider performance status, cancer burden, possible toxicity, and previously applied therapy. […] If local therapy is unfeasible, selected patients, especially those with human epidermal growth factor receptor 2-positive breast cancer, may benefit from systemic therapy. […] The benefit of WBRT is disputable. Systemic treatment may be an alternative option if local therapy is not feasible. […] The selection of methods depends on performance status, disease burden, comorbidities, a biological subtype of breast cancer, and previously used therapies.

• #65 Salvage Treatment for Progressive Brain Metastases in Breast Cancer

  https://www.mdpi.com/2072-6694/14/4/1096

  The choice of optimal methods should be carefully discussed within the multidisciplinary tumor board. […] Repeated local therapy may provide a significant benefit in intracranial progression-free survival and overall survival. However, it could lead to significant toxicity. […] The choice of treatment method must consider performance status, cancer burden, possible toxicity, and previously applied therapy. […] If local therapy is unfeasible, selected patients, especially those with human epidermal growth factor receptor 2-positive breast cancer, may benefit from systemic therapy. […] The benefit of WBRT is disputable. Systemic treatment may be an alternative option if local therapy is not feasible. […] The selection of methods depends on performance status, disease burden, comorbidities, a biological subtype of breast cancer, and previously used therapies.

• #66 Brain Metastases Program | Froedtert & MCW

  https://www.froedtert.com/brainmets

  The brain metastasis tumor board is an efficient and effective treatment-planning tool. […] Recognizing this need, radiation oncologists and others within the Froedtert MCW Cancer Network developed a protocol grid to guide treatment for every type of brain metastasis. […] The protocol grids intense complexity made it an ideal candidate for developing an app we call the Network for Integrated Management of Brain Metastasis Linking Experts, or NIMBLE. The app is essentially a virtual tumor board connecting cancer doctors with brain metastasis specialists who provide treatment recommendations in hours, not days.

• #67 Treatment for Metastatic Brain Cancer | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/brain-tumors-metastatic/treatment

  To create your treatment plan, our experts assess the number and location of tumors and your overall health. We may recommend surgery, radiation, or a combination to treat your disease. Most brain metastases do not get better with chemotherapy, so we rarely recommend it. […] Before we recommend any treatment, you will talk with the care team at our Multidisciplinary Brain Metastasis Center. You will meet with a surgeon and radiation oncologist (a doctor who uses radiation to treat cancer). You may also see a medical oncologist (a doctor who uses drugs to treat cancer). These experts will evaluate you and find the best care plan for you. […] You may be able to join one of our clinical trials. These research studies explore new treatments for brain metastases. […] We will help you manage the side effects of treatment. Rehabilitation is an important part of your care. Physical and occupational therapy can help you get back to your daily activities and we also have a special program for speech and hearing problems.

• #68 Clinical Trials to Treat Adult Metastatic Brain Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/adult-metastatic-brain-tumors

  Testing Longer Duration Radiation Therapy Versus the Usual Radiation Therapy in Patients with Cancer That Has Spread to the Brain. This phase III trial compares the effectiveness of fractionated stereotactic radiosurgery (FSRS) to usual care stereotactic radiosurgery (SRS) in treating patients with cancer that has spread from where it first started to the brain. […] Comparing the Addition of Radiation either before or after Surgery for Patients with Brain Metastases. This phase III trial compares the usual treatment of surgery after stereotactic radiosurgery (SRS) to receiving SRS before surgery in treating patients with cancer that has spread to the brain (brain metastases). […] Genetic Testing in Guiding Treatment for Patients with Brain Metastases. This phase II trial studies how well genetic testing works in guiding treatment for patients with solid tumors that have spread to the brain.

• #69 Clinical Trials to Treat Adult Metastatic Brain Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/adult-metastatic-brain-tumors

  Testing Longer Duration Radiation Therapy Versus the Usual Radiation Therapy in Patients with Cancer That Has Spread to the Brain. This phase III trial compares the effectiveness of fractionated stereotactic radiosurgery (FSRS) to usual care stereotactic radiosurgery (SRS) in treating patients with cancer that has spread from where it first started to the brain. […] Comparing the Addition of Radiation either before or after Surgery for Patients with Brain Metastases. This phase III trial compares the usual treatment of surgery after stereotactic radiosurgery (SRS) to receiving SRS before surgery in treating patients with cancer that has spread to the brain (brain metastases). […] Genetic Testing in Guiding Treatment for Patients with Brain Metastases. This phase II trial studies how well genetic testing works in guiding treatment for patients with solid tumors that have spread to the brain.

• #70 Clinical Trials to Treat Adult Metastatic Brain Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/adult-metastatic-brain-tumors

  Testing Longer Duration Radiation Therapy Versus the Usual Radiation Therapy in Patients with Cancer That Has Spread to the Brain. This phase III trial compares the effectiveness of fractionated stereotactic radiosurgery (FSRS) to usual care stereotactic radiosurgery (SRS) in treating patients with cancer that has spread from where it first started to the brain. […] Comparing the Addition of Radiation either before or after Surgery for Patients with Brain Metastases. This phase III trial compares the usual treatment of surgery after stereotactic radiosurgery (SRS) to receiving SRS before surgery in treating patients with cancer that has spread to the brain (brain metastases). […] Genetic Testing in Guiding Treatment for Patients with Brain Metastases. This phase II trial studies how well genetic testing works in guiding treatment for patients with solid tumors that have spread to the brain.

• #71 Clinical Trials to Treat Adult Metastatic Brain Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/adult-metastatic-brain-tumors

  Stereotactic Radiosurgery or Hippocampus Avoidance Whole-Brain Radiation Therapy with Memantine in Treating Patients with 5 or more Brain Metastases. This phase III trial studies stereotactic radiosurgery to see how well it works compared to hippocampus avoidance whole-brain radiation therapy with memantine in treating patients with 5 or more brain tumors that have spread from other places in the body. […] Post-Surgical Stereotactic Radiotherapy (SRT) Versus GammaTile-ROADS (Radiation One and Done Study). This trial will be a randomized controlled study comparing the efficacy and safety of intraoperative radiation therapy using GammaTilesTM (GT) versus SRT 3-4 weeks following metastatic tumor resection which is the current standard of care. […] Cs131 Brachytherapy for the Treatment of Recurrent Brain Metastases. This phase II trial studies the effect of cesium (Cs)-131 brachytherapy in treating patients with cancer that has spread to the brain from other places in the body (brain metastases) and that has come back (recurrent).

• #72 Clinical Trials to Treat Adult Metastatic Brain Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/adult-metastatic-brain-tumors

  Stereotactic Radiosurgery or Hippocampus Avoidance Whole-Brain Radiation Therapy with Memantine in Treating Patients with 5 or more Brain Metastases. This phase III trial studies stereotactic radiosurgery to see how well it works compared to hippocampus avoidance whole-brain radiation therapy with memantine in treating patients with 5 or more brain tumors that have spread from other places in the body. […] Post-Surgical Stereotactic Radiotherapy (SRT) Versus GammaTile-ROADS (Radiation One and Done Study). This trial will be a randomized controlled study comparing the efficacy and safety of intraoperative radiation therapy using GammaTilesTM (GT) versus SRT 3-4 weeks following metastatic tumor resection which is the current standard of care. […] Cs131 Brachytherapy for the Treatment of Recurrent Brain Metastases. This phase II trial studies the effect of cesium (Cs)-131 brachytherapy in treating patients with cancer that has spread to the brain from other places in the body (brain metastases) and that has come back (recurrent).

• #73 Clinical Trials to Treat Adult Metastatic Brain Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/adult-metastatic-brain-tumors

  Stereotactic Radiosurgery for the Treatment of Brain Metastases from Small Cell Lung Cancer. This phase II trial tests whether stereotactic radiosurgery (SRS) works to shrink tumors in people with small cell lung cancer that has spread to the brain (brain metastases). […] A Study of Stereotactic Radiosurgery (SRS) and Standard Treatment in People with EGFR-Mutated Lung Cancer That Has Spread to the Brain, ICON-RT Trial. This phase II clinical trial studies the effect of adding consolidative stereotactic radiosurgery (SRS) to standard treatment in comparison to standard therapy alone for the treatment of patients with non-small cell lung cancer (NSCLC) that has spread to the brain (metastasis) and whose cancer has a change (mutation) in the epidermal growth factor receptor (EGFR) gene. […] A Study of Cabozantinib and Nivolumab With Radiation Therapy for People With Renal Cell Carcinoma that has Spread to the Brain. This phase Ib trial evaluates the safety and effectiveness of combination cabozantinib and nivolumab added to standard stereotactic radiosurgery for treating patients with renal cell (kidney) cancer that has spread from where it first started (primary site) to the brain (brain metastases).

• #74 Brain Metastases Treatment | UVA Health

  https://uvahealth.com/services/brain-cancer-treatment/brain-metastases

  Taking out the tumors can relieve pressure on your brain and lessen your symptoms. Our surgeons are experts in operating on this critical part of the body. […] Through clinical trials, we bring you treatments you can’t find anywhere else. Our research improves and prolongs patients’ lives. We’ll help you find clinical trials that can help you.

• #75

  https://link.springer.com/article/10.1007/s11864-024-01195-3

  Radiation-induced cognitive decline (RICD), another toxicity of brain radiotherapy, has been a growing concern for patients and providers as patients with brain metastases are living longer than they had in the past. […] The presence of the blood brain barrier (BBB) prevents larger molecules and water-soluble substances from passing into the brain. This has prevented cytotoxic chemotherapies and many targeted agents from reaching brain metastases, leaving surgery and radiotherapy as the first-line options for treatment of brain metastases. […] The role of systemic agents in the management of brain metastases from melanoma has also increased over time. […] The breast cancer population with brain metastases commonly has a longer survival than brain metastasis patients with other primary cancers due to the many effective systemic therapies for metastatic breast cancer.

• #76 Treatment strategies for breast cancer brain metastases | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01175-y

  For systemic therapies, various drugs, including older chemotherapy agents such as capecitabine, cyclophosphamide, 5-fluorouracil, methotrexate, vincristine, cisplatin, etoposide, vinorelbine and gemcitabine, have shown activity in the treatment of BM, with an objective response rate (ORR) of over 30%. […] New chemotherapy agents, such as third-generation taxanes, are in development for the specific indication of BCBM. […] To date, evidence for the direct efficacy of HER2-targeting monoclonal antibodies trastuzumab, trastuzumab-emtansine (T-DM1) and pertuzumab on BMBC is based on the retrospective subgroup analysis of clinical trials or on small cohorts. […] These studies show a correlation between the use of trastuzumab and the development of less aggressive BM. […] The best results published to date have been obtained in patients with BM from HER2+ MBC, for whom all currently used combinations of chemotherapy and anti-HER2 therapy have shown some efficacy, with particularly impressive results obtained with the tucatinib-trastuzumab-capecitabine combination. […] The individuality of patients with BCBM, in terms of clinical characteristics and treatment resistance, makes it necessary to develop specific clinical trials to generate new treatment strategies.

• #77 Management of Lung Cancer Brain Metastases: An Update | Consult QD

  https://consultqd.clevelandclinic.org/management-of-lung-cancer-brain-metastases-an-update

  We now have an expanded toolbox to extend survival and lessen treatment toxicity. The safe and effective management of lung cancer brain metastases is coming to the fore. The goals we always keep in mind in these cases are to extend survival, prevent neurological dysfunction and improve quality of life. In most cases, adding whole brain radiation therapy (WBRT) or stereotactic radiosurgery to surgery has been essential to increase survival and reduce tumor recurrences. Most importantly, WBRT is associated with neurocognitive decline, which becomes more evident as patients live longer than one year. This risk can be lowered by newer approaches such as medications (e.g., memantine) or modified radiation delivery such as hippocampal sparing during WBRT; however, delayed impact on cognition continues to be a factor. WBRT is still considered necessary for leptomeningeal disease and for cases involving numerous metastatic lesions, although the threshold is not well defined and is rising as other therapies prove effective for multiple metastases. Stereotactic radiosurgery offers multiple advantages over many other therapies, including lower cost and, in most cases, avoidance of general anesthesia for surgery. It also can be used as salvage treatment for recurrence of metastases following WBRT. Comparable to WBRT in terms of overall survival and local and distant control, it allows faster time to systemic therapy and causes fewer toxicities, including neurocognitive impairment. For large brain metastases ( 2 cm), single-session radiosurgery does not consistently provide durable control. Instead, we recommend staged treatment i.e., two stereotactic radiosurgery treatments performed one month apart effectively boosting the target and achieving approximately 90% one-year local control. In recent years, we have changed how we treat non-small cell lung cancer (NSCLC) tumors driven by epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements, and this has had significant impact on control of lung cancer-related brain metastases. Since 2015, TKIs with CNS activity have become available and have quickly moved from second-line to frontline therapy. We now even have data supporting adjuvant use of one TKI, osimertinib, for EGFR-positive tumors. These developments have given us the welcome option of withholding WBRT in TKI-nave patients. In cases of EGFR or ALK-driven tumors with brain metastases, virtually all patients who are TKI-nave receive TKI therapy plus stereotactic radiosurgery. Even as the field grapples with these questions, the progress of the past few years particularly the advent of systemic therapies and improvements in the use of stereotactic radiosurgery deserves recognition.

• #78 Management of Lung Cancer Brain Metastases: An Update | Consult QD

  https://consultqd.clevelandclinic.org/management-of-lung-cancer-brain-metastases-an-update

  We now have an expanded toolbox to extend survival and lessen treatment toxicity. The safe and effective management of lung cancer brain metastases is coming to the fore. The goals we always keep in mind in these cases are to extend survival, prevent neurological dysfunction and improve quality of life. In most cases, adding whole brain radiation therapy (WBRT) or stereotactic radiosurgery to surgery has been essential to increase survival and reduce tumor recurrences. Most importantly, WBRT is associated with neurocognitive decline, which becomes more evident as patients live longer than one year. This risk can be lowered by newer approaches such as medications (e.g., memantine) or modified radiation delivery such as hippocampal sparing during WBRT; however, delayed impact on cognition continues to be a factor. WBRT is still considered necessary for leptomeningeal disease and for cases involving numerous metastatic lesions, although the threshold is not well defined and is rising as other therapies prove effective for multiple metastases. Stereotactic radiosurgery offers multiple advantages over many other therapies, including lower cost and, in most cases, avoidance of general anesthesia for surgery. It also can be used as salvage treatment for recurrence of metastases following WBRT. Comparable to WBRT in terms of overall survival and local and distant control, it allows faster time to systemic therapy and causes fewer toxicities, including neurocognitive impairment. For large brain metastases ( 2 cm), single-session radiosurgery does not consistently provide durable control. Instead, we recommend staged treatment i.e., two stereotactic radiosurgery treatments performed one month apart effectively boosting the target and achieving approximately 90% one-year local control. In recent years, we have changed how we treat non-small cell lung cancer (NSCLC) tumors driven by epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements, and this has had significant impact on control of lung cancer-related brain metastases. Since 2015, TKIs with CNS activity have become available and have quickly moved from second-line to frontline therapy. We now even have data supporting adjuvant use of one TKI, osimertinib, for EGFR-positive tumors. These developments have given us the welcome option of withholding WBRT in TKI-nave patients. In cases of EGFR or ALK-driven tumors with brain metastases, virtually all patients who are TKI-nave receive TKI therapy plus stereotactic radiosurgery. Even as the field grapples with these questions, the progress of the past few years particularly the advent of systemic therapies and improvements in the use of stereotactic radiosurgery deserves recognition.

• #79 Brain Metastases – AIM at Melanoma Foundation

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

  Surgery is a standard treatment for melanoma brain metastases. It is potentially curative for patients whose melanoma is otherwise controlled and who have a limited number of brain metastases. […] Stereotactic radiosurgery (SRS) targets certain spots in the brain. […] Whole-brain radiation treatment (WBRT) treats brain metastases that can be seen, as well as tumor cells that are too small to be identified by MRI or CT scans. […] Brain metastases can cause swelling in the brain which can result in a variety of symptoms, including headache, nausea, vomiting, and/or confusion. Steroids can reduce swelling in the brain and, therefore, are often used to treat the symptoms caused by brain metastases. […] Most FDA-approved checkpoint inhibitor-based immunotherapies can achieve significant shrinkage of melanoma brain metastases.

• #80 Brain Metastasis Treatment & Management: Medical Care, Surgical Care

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

  Medical treatment directed at cancer cells that have seeded into the brain is ineffective. […] A variety of chemotherapeutic agents have been used to treat brain metastasis from lung, breast, and melanoma, including cisplatin, cyclophosphamide, etoposide, teniposide, mitomycin, irinotecan, vinorelbine, etoposide, ifosfamide, temozolomide, fluorouracil (5FU), and prednisone. […] In most cases, 2-3 of these agents are used in combination and in conjunction with whole-brain radiation therapy (WBRT). […] The advent in small-molecule tyrosine kinase inhibitors (tyrKi) and monoclonal antibodies has helped transform the management of brain metastasis. […] Radiation therapy has become a mainstream therapy for brain metastasis. […] For decades, WBRT has been advocated for patients with multiple lesions.

• #81 Management of complications from brain metastasis treatment: a narrative review – Diao – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/81425/html

  Objective: To describe the range of potential side effects associated with modern brain metastasis treatment and provide evidenced-based guidance on the effective management of these side effects. […] The standard treatment for brain metastases until the 1990s was whole-brain radiation therapy (WBRT) alone. Since then, however, numerous advances have established the role of neurosurgical resection, stereotactic radiosurgery (SRS), targeted systemic therapy, and immunotherapy in the multidisciplinary management of brain metastases and led to improvements in intracranial control, survival, and neurocognitive preservation among patients with brain metastases. […] In this review, we summarize the major complications from intracranial radiotherapy, neurosurgical resection, and brain metastasis directed systemic therapy with corresponding evidenced-based, modern management principles to guide the practicing oncologist.

• #82 Management of complications from brain metastasis treatment: a narrative review – Diao – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/81425/html

  As patients survive longer following brain metastasis treatment, however, late neurologic complications from brain metastasis directed therapy are also becoming more likely. […] The primary management of acute fatigue in patients undergoing brain radiotherapy is supportive care, including appropriate steroid taper, advising patients to take steroids earlier in the day (second dose no later than mid-afternoon) to avoid sleep disturbance, and other good sleep hygiene measures. […] In patients with symptomatic radiation necrosis, systemic corticosteroids such as dexamethasone are the first-line treatment. […] Bevacizumab is a monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). It has been studied for treatment of radiation necrosis in two randomized controlled trials.

• #83 Management of complications from brain metastasis treatment: a narrative review – Diao – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/81425/html

  As patients survive longer following brain metastasis treatment, however, late neurologic complications from brain metastasis directed therapy are also becoming more likely. […] The primary management of acute fatigue in patients undergoing brain radiotherapy is supportive care, including appropriate steroid taper, advising patients to take steroids earlier in the day (second dose no later than mid-afternoon) to avoid sleep disturbance, and other good sleep hygiene measures. […] In patients with symptomatic radiation necrosis, systemic corticosteroids such as dexamethasone are the first-line treatment. […] Bevacizumab is a monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). It has been studied for treatment of radiation necrosis in two randomized controlled trials.

• #84 Management of complications from brain metastasis treatment: a narrative review – Diao – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/81425/html

  The use of fraction sizes 3 Gy with WBRT appeared to lead to higher risk for developing severe dementia. […] The use of the N-methyl-D-aspartate (NMDA) receptor antagonist memantine during and for 6 months after WBRT improved preservation of cognitive function, executive function, processing speed, and delayed recognition although its primary endpoint of delayed recall did not reach statistical significance. […] Radiation-induced optic neuropathy (RION) is one of the most feared complications of intracranial radiation due to its devastating consequences. […] Proven treatment options for RION are limited. […] Historically, patients with brain metastases rarely survived long enough to develop clinically significant hypothalamic-pituitary (HP) axis dysfunction following treatment of brain metastases with radiotherapy and HP dysfunction in this population is therefore not well-described in literature.

• #85 Management of complications from brain metastasis treatment: a narrative review – Diao – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/81425/html

  The use of fraction sizes 3 Gy with WBRT appeared to lead to higher risk for developing severe dementia. […] The use of the N-methyl-D-aspartate (NMDA) receptor antagonist memantine during and for 6 months after WBRT improved preservation of cognitive function, executive function, processing speed, and delayed recognition although its primary endpoint of delayed recall did not reach statistical significance. […] Radiation-induced optic neuropathy (RION) is one of the most feared complications of intracranial radiation due to its devastating consequences. […] Proven treatment options for RION are limited. […] Historically, patients with brain metastases rarely survived long enough to develop clinically significant hypothalamic-pituitary (HP) axis dysfunction following treatment of brain metastases with radiotherapy and HP dysfunction in this population is therefore not well-described in literature.

• #86 Management of complications from brain metastasis treatment: a narrative review – Diao – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/81425/html

  The use of fraction sizes 3 Gy with WBRT appeared to lead to higher risk for developing severe dementia. […] The use of the N-methyl-D-aspartate (NMDA) receptor antagonist memantine during and for 6 months after WBRT improved preservation of cognitive function, executive function, processing speed, and delayed recognition although its primary endpoint of delayed recall did not reach statistical significance. […] Radiation-induced optic neuropathy (RION) is one of the most feared complications of intracranial radiation due to its devastating consequences. […] Proven treatment options for RION are limited. […] Historically, patients with brain metastases rarely survived long enough to develop clinically significant hypothalamic-pituitary (HP) axis dysfunction following treatment of brain metastases with radiotherapy and HP dysfunction in this population is therefore not well-described in literature.

• #87 Having radiotherapy for brain metastases | Lung cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/lung-cancer/treatment/radiotherapy/radiotherapy-for-brain-metastases

  Radiotherapy uses high energy x-rays to destroy cancer cells. You might have radiotherapy to the brain if your lung cancer has spread there (metastases). You can have radiotherapy in the following ways: stereotactic radiosurgery, stereotactic radiotherapy, whole brain radiotherapy. Your doctor will tell you which treatment is best for your situation. […] Your doctor might suggest radiotherapy to the brain if your cancer has spread there. What type of radiotherapy you have might depend on the number of brain metastases you have and how well you are. If you have stereotactic radiosurgery, you usually have one treatment. If you have stereotactic radiotherapy, you might have up to 5 treatments. Whole brain radiotherapy is usually given over 5 to 10 treatments. […] Radiotherapy to the brain can cause side effects. Let your doctor, nurse or radiographer know about any side effects that you have. Then they can find ways to help you. They generally last a number of weeks. Some might last for a few months after the treatment has finished. Your doctor will tell you more about long term side effects.

• #88 Having radiotherapy for brain metastases | Lung cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/lung-cancer/treatment/radiotherapy/radiotherapy-for-brain-metastases

  Radiotherapy to the brain can make you feel very tired. The tiredness usually comes on gradually as you go through your treatment. By the end of the course of treatment, some people may notice drowsiness or a desire to sleep. This is also called somnolence. […] You might feel sick at times. You can have anti sickness medicines. Let your treatment team know if you still feel sick, as they can give you another type. […] Tell your healthcare team if you keep getting headaches. They can give you painkillers to help. […] Your skin can feel sore. This may start after your radiotherapy treatment is completed. Your radiographers may give you creams to soothe your skin. The severity of the skin reaction varies from person to person. […] Radiotherapy to the brain can cause hair loss in the treatment area. Your hair usually starts to grow back a few months after treatment ends. But this growth may be patchy at first. […] Your doctor will discuss with you any possible long term side effects from your type of radiotherapy.

• #89 Metastatic Brain Cancer

  https://www.rwjbh.org/treatment-care/neuroscience/neurosurgery/conditions-treated/brain-metastases/

  If your tumor(s) are in places that are accessible for an operation, your neurosurgeon will remove as much as the cancer as possible. […] Removing brain metastases through craniotomy surgery has certain risks, including the possibility of neurologic deficits, infection, and bleeding. […] Many metastatic brain cancer patients are ideally suited to radiosurgery treatment such as those delivered by Gamma Knife or CyberKnife technology. […] High-dose corticosteroids can reduce brain swelling and decrease neurological symptoms. […] These research studies explore and test new treatments to prevent, detect, and manage metastatic brain cancer. […] While no alternative medicine approach has been proven to cure cancer, complementary therapies can help patients cope with side effects of their other treatment. […] The best person to ask about survival is your treatment team, who may be able to estimate how long you can live with brain metastases based on what they know about your situation; but even then, it is only an estimate.

• #90 Metastatic Brain Disease Treatment for International Patients | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/international/treatments-and-specialties/cancer-care/neuro-oncology/metastatic-disease

  Brain metastasis (metastatic brain cancer) occurs when cancer starts in another part of the body (e.g., lung, breast, skin) and spreads to the brain. It is the most common type of brain cancer. […] Every case of metastatic brain disease is unique, as is every patient’s needs and preferences. The neurosurgeons and cancer specialists at Mass General Brigham will work with you and your family to develop a treatment plan to address your particular situation. […] At Mass General Brigham, you will find all of the latest treatments for brain metastases and leptomeningeal disease. Your care team may use one or more of various approaches to give you the best chance at a successful outcome. […] Treatment aims to ease your symptoms and to slow or stop tumor growth within the nervous system. Our multidisciplinary team of specialists will meet to plan your treatment, which may include one or more of the following options: Surgery, in which your neurosurgeon removes as much of the tumor as safely possible; Radiation therapy, which uses high-energy beams (e.g., X-rays) to shrink or kill cancer cells without damaging healthy normal cells around the tumor; Proton beam therapy, an advanced form of radiation treatment that uses a high-energy, focused proton beam to target tumors with incredible precision; Chemotherapy, which uses drugs (given intravenously or orally) to destroy cancer cells in the nervous system and in the body; Immunotherapy, which harnesses the power of your own immune system to find and attack cancer cells; Targeted therapy, a form of personalized medicine in which a drug is chosen based on the specific genetic mutation or alteration found in a tumor’s cells; Clinical trials of promising new drugs for brain metastases.

• #91

  https://link.springer.com/article/10.1007/s11864-024-01195-3

  Therapies for brain metastasis continue to evolve as the life expectancies for patients have continued to prolong. Novel advances include the use of improved technology for radiation delivery, surgical guidance, and response assessment, along with systemic therapies that can pass through the blood brain barrier. […] Systemic therapies that cross the blood brain barrier as well as novel technologies such as hippocampal avoidant whole brain radiation (WBRT) and laser interstitial thermotherapy have begun carving out important roles in brain metastasis management. […] Pharmacologic options for mitigation of radiation-induced brain toxicity have improved over time. Dexamethasone has been used for the management of vasogenic edema for decades. […] In cases of more significant radiation necrosis, bevacizumab has emerged as a non-surgical option to treat radiation necrosis.

• #92

  https://link.springer.com/article/10.1007/s11864-024-01195-3

  Radiation therapy has evolved over time for treatment of brain metastases. Several randomized trials have now demonstrated that for patients with 4 or fewer brain metastases, SRS leads to improved cognitive outcomes over WBRT. […] The role of surgery for brain metastases has generally been in the setting of large or symptomatic disease. In these cases, surgical removal may improve both survival and functional independence. […] Craniotomy can be performed to remove larger tumors (3 cm), to acquire pathologic confirmation of cancer and/or relevant mutations/treatment targets, and to remove lesions causing significant mass effect. […] A phase III trial is being conducted for the use of TTF in conjunction with SRS for patients with brain metastases from NSCLC. […] MRgFUS is being assessed as a treatment option for brain metastases because of its ability to disrupt the blood brain barrier and allow for entry of systemically administered agents that otherwise may not cross the blood brain barrier. […] The Alliance A071701 study is investigating the use of genomically-guided treatment for progressive brain metastases.

• #93

  https://link.springer.com/article/10.1007/s11864-024-01195-3

  Radiation therapy has evolved over time for treatment of brain metastases. Several randomized trials have now demonstrated that for patients with 4 or fewer brain metastases, SRS leads to improved cognitive outcomes over WBRT. […] The role of surgery for brain metastases has generally been in the setting of large or symptomatic disease. In these cases, surgical removal may improve both survival and functional independence. […] Craniotomy can be performed to remove larger tumors (3 cm), to acquire pathologic confirmation of cancer and/or relevant mutations/treatment targets, and to remove lesions causing significant mass effect. […] A phase III trial is being conducted for the use of TTF in conjunction with SRS for patients with brain metastases from NSCLC. […] MRgFUS is being assessed as a treatment option for brain metastases because of its ability to disrupt the blood brain barrier and allow for entry of systemically administered agents that otherwise may not cross the blood brain barrier. […] The Alliance A071701 study is investigating the use of genomically-guided treatment for progressive brain metastases.

• #94

  https://link.springer.com/article/10.1007/s11864-024-01195-3

  Radiation therapy has evolved over time for treatment of brain metastases. Several randomized trials have now demonstrated that for patients with 4 or fewer brain metastases, SRS leads to improved cognitive outcomes over WBRT. […] The role of surgery for brain metastases has generally been in the setting of large or symptomatic disease. In these cases, surgical removal may improve both survival and functional independence. […] Craniotomy can be performed to remove larger tumors (3 cm), to acquire pathologic confirmation of cancer and/or relevant mutations/treatment targets, and to remove lesions causing significant mass effect. […] A phase III trial is being conducted for the use of TTF in conjunction with SRS for patients with brain metastases from NSCLC. […] MRgFUS is being assessed as a treatment option for brain metastases because of its ability to disrupt the blood brain barrier and allow for entry of systemically administered agents that otherwise may not cross the blood brain barrier. […] The Alliance A071701 study is investigating the use of genomically-guided treatment for progressive brain metastases.

• #95 Clinical Trials to Treat Adult Metastatic Brain Tumors – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/research/participate/clinical-trials/adult-metastatic-brain-tumors

  Study of Stereotactic Radiosurgery With Olaparib Followed by Durvalumab and Physician’s Choice Systemic Therapy in Subjects With Breast Cancer Brain Metastases. This study is a Phase I/II study evaluating the safety and effectiveness of focused radiation therapy (radiosurgery) together with olaparib, followed by immunotherapy, for patients with brain metastases from triple negative or BRCA-mutated breast cancers. […] Pre-Operative or Post-Operative Stereotactic Radiosurgery in Treating Patients with Operative Metastatic Brain Tumors. This phase III trial studies the side effects and how well stereotactic radiosurgery (SRS) works before or after surgery in patients with tumors that has spread to the brain or that can be removed by surgery. […] Dendritic Cell Vaccines against Her2/Her3 and Pembrolizumab for the Treatment of Brain Metastasis from Triple Negative Breast Cancer or HER2+ Breast Cancer or Hormone Receptor Positive Breast Cancer. This phase IIa trial studies how well dendritic cell vaccines against Her2/Her3 and pembrolizumab work for the treatment of triple negative breast cancer, HER2+ breast cancer, or hormone receptor (HR) positive breast cancer that has spread to the brain (brain metastasis).

• #96 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  Sometimes, your healthcare team may recommend medicines to control your brain metastases. Whether they may help depends on where your cancer started and your own situation. Options may include: Chemotherapy. Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Most chemotherapy medicines are given through a vein. Some come in pill form. Targeted therapy. Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatment can cause cancer cells to die. Immunotherapy. Immunotherapy for cancer is a treatment with medicine that helps the body’s immune system kill cancer cells. […] Palliative care is a special type of health care that helps people with serious illnesses feel better. It’s also called supportive care. If you have cancer, palliative care can help relieve pain and other symptoms. […] Palliative care can happen at the same time as treatments such as surgery, radiation therapy or chemotherapy.

• #97 Brain Metastases Treatment Program | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/treatment/neuro-oncology/programs/brain-metastases

  At Dana-Farber Brigham Cancer Center, our multidisciplinary Brain Metastases Program team develops an individualized treatment plan for each patient whether for a first-time diagnosis or for a recurrence of brain metastases since prior treatment. […] We offer the latest advances in the treatment of metastatic brain tumors. Treatment options may include: Surgery, Laser ablation, Radiation therapy, Systemic therapies including immunotherapy, targeted therapy, and chemotherapy, Clinical trials. […] In addition to patients with brain metastases, we also treat patients with cancer that has metastasized to other parts of the central nervous system. […] At the BMP, we offer comprehensive care of each patient mind and body. We offer special support services and follow-up care designed for patients with brain tumors. Our psychosocial oncology, cancer neurology, and pain specialists can help patients manage their symptoms, including neurocognitive deficits, in order to maintain the best possible quality of life during and after treatment. […] Antibody-drug conjugate found effective against brain metastases in patients with HER2-positive breast cancer. […] Mother with Rare Type of Brain Metastasis Doing Well on Novel Treatment. […] Whats On The Horizon For Brain Tumor Treatment?

• #98 Role of Brain Metastases and Quality of Life in Treatment Decisionmaking

  https://www.onclive.com/view/role-of-brain-metastases-and-quality-of-life-in-treatment-decisionmaking

  When we treat a patient with metastatic breast cancer we have 2 goals: having the patient live longer and having the patient live better; better their quality of life. We must achieve both at the same time, but this can be hard because our treatments have adverse events while treating the cancer and improving some symptoms related to the cancer. Quality of life is extremely important, especially in HER2+ disease where we have our patients that live for more than 5 years. […] Picking a treatment that is well tolerated is extremely important because, as I describe it to my patients, this is a marathon, it’s not a sprint. So, giving a lot of treatment upfront and causing a lot of toxicity may prevent us from being able to give treatment later. That is extremely important because we have many options for our patients. Some of these trials are treating patients in the eleventh-line setting, so these patients are going to get a lot of treatment and we need to somehow pace ourselves to be able to provide control of the disease without compromising the quality of life. I use the data from quality of life studies in the clinical trials because these are extremely helpful, and help guide our decision-making.

• #99 Role of Brain Metastases and Quality of Life in Treatment Decisionmaking

  https://www.onclive.com/view/role-of-brain-metastases-and-quality-of-life-in-treatment-decisionmaking

  When we treat a patient with metastatic breast cancer we have 2 goals: having the patient live longer and having the patient live better; better their quality of life. We must achieve both at the same time, but this can be hard because our treatments have adverse events while treating the cancer and improving some symptoms related to the cancer. Quality of life is extremely important, especially in HER2+ disease where we have our patients that live for more than 5 years. […] Picking a treatment that is well tolerated is extremely important because, as I describe it to my patients, this is a marathon, it’s not a sprint. So, giving a lot of treatment upfront and causing a lot of toxicity may prevent us from being able to give treatment later. That is extremely important because we have many options for our patients. Some of these trials are treating patients in the eleventh-line setting, so these patients are going to get a lot of treatment and we need to somehow pace ourselves to be able to provide control of the disease without compromising the quality of life. I use the data from quality of life studies in the clinical trials because these are extremely helpful, and help guide our decision-making.

• #100 Treatment for Metastatic Brain Cancer | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/brain-tumors-metastatic/treatment

  To create your treatment plan, our experts assess the number and location of tumors and your overall health. We may recommend surgery, radiation, or a combination to treat your disease. Most brain metastases do not get better with chemotherapy, so we rarely recommend it. […] Before we recommend any treatment, you will talk with the care team at our Multidisciplinary Brain Metastasis Center. You will meet with a surgeon and radiation oncologist (a doctor who uses radiation to treat cancer). You may also see a medical oncologist (a doctor who uses drugs to treat cancer). These experts will evaluate you and find the best care plan for you. […] You may be able to join one of our clinical trials. These research studies explore new treatments for brain metastases. […] We will help you manage the side effects of treatment. Rehabilitation is an important part of your care. Physical and occupational therapy can help you get back to your daily activities and we also have a special program for speech and hearing problems.

• #101 Treatment for Metastatic Brain Cancer | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/brain-tumors-metastatic/treatment

  To create your treatment plan, our experts assess the number and location of tumors and your overall health. We may recommend surgery, radiation, or a combination to treat your disease. Most brain metastases do not get better with chemotherapy, so we rarely recommend it. […] Before we recommend any treatment, you will talk with the care team at our Multidisciplinary Brain Metastasis Center. You will meet with a surgeon and radiation oncologist (a doctor who uses radiation to treat cancer). You may also see a medical oncologist (a doctor who uses drugs to treat cancer). These experts will evaluate you and find the best care plan for you. […] You may be able to join one of our clinical trials. These research studies explore new treatments for brain metastases. […] We will help you manage the side effects of treatment. Rehabilitation is an important part of your care. Physical and occupational therapy can help you get back to your daily activities and we also have a special program for speech and hearing problems.

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