Integrated treatment of brain metastases

Rosenfelder, Nicola and Brada, Michael (2019) Integrated treatment of brain metastases. CURRENT OPINION IN ONCOLOGY, 31 (6). pp. 501-507.

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Abstract

<h4>Purpose of review</h4>Optimal treatment of brain metastases has been limited to local treatment with few systemic options. Increasing use of systemic targeted therapies, chemotherapy and immunotherapy and combination of local and systemic treatments has resulted in plethora of publications. We review the existing evidence for individual treatments and new evidence for the integration of systemic and combination of local treatments.<h4>Recent findings</h4>Encouraging efficacy of systemic therapies supports combination of systemic and local treatment albeit with little randomized trial data. Efficacy particularly of targeted agents provides an opportunity to delay local treatments including radiosurgery and whole brain radiotherapy. Randomized trials testing the integration of surgery, radiotherapy and radiosurgery are reviewed with emphasis on patient relevant endpoints to guide the clinician in the choice and sequence of treatments and integrating systemic and local therapies.<h4>Summary</h4>There is increasing tendency to use focused radiation for single and oligometastases with or without surgery and decline in whole brain radiotherapy which is limited to multiple metastases in tumours without effective systemic options. Systemic therapies have promising intracranial efficacy and the sequence and combination with localized radiation is awaiting trials. Changes in practice with a move to primary systemic treatment for brain metastases without radiation, should be undertaken with caution and close monitoring.

Item Type:	Article
Uncontrolled Keywords:	stereotactic radiosurgery for brain metastases, surgery for brain metastases, systemic therapy for brain metastases
Depositing User:	Symplectic Admin
Date Deposited:	08 Dec 2020 08:12
Last Modified:	18 Jan 2023 23:19
DOI:	10.1097/CCO.0000000000000573
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3109557