Brain metatases
occur in 20-40% of patients with cancer. Median survival of patients who
develop brain metastases is relatively short - 4 months. Treatment methods such
as Whole Brain Radio Therapy (WBRT), Surgery (S) or Radiosurgery (SRS) prolong
survival for 3 to 5 months. Treatment options in brain metastases are as
follows: symptomatic tratment, surgery, radiotherapy, chemiotherapy and
combination of those. Symptomatic treatment of edema and anticonvulsive therapy
are used if necessery and depends on neurological patients status. Surgery has
been used for single brain metstasis in patients with good performance status.
WBRT alone is a treatment of choice for patients with multiple brain metastases,
with single brain metastasis not sutable to surgery or radiosurgery, especially
those with an active and disseminated systemic disease. SRS is an external
irradiation technique to deliver a relatively large radiation dose in a single
fraction to an intracranial small target volume.
Chemotherapy alone
(CT) is not used unless in clinical trials. Which method to use depends on
profile of prognosis factors such as:performance status, patients age,number
and volume of metastases. Brain metastasis is a common
manifestation of disseminated malignancy. In adults, lung, (36-40%),
breast cancer (15-25%) and skin melanoma (5-20%) are the most common sources of
brain metastases. Less frequent are colon, rectal, kidney, prostate,
testicular, ovarian cancer and sarcoma. Cerebral lesion are mainly located in
hemispheres (80%), in cerebellum (15%), in the brain stem (5%), being very rare
in the basal ganglia, the pineal gland or hypophysis.
Are more common than
primary brain tumors. Frequency of disclosure is the result: a more
effective treatment of the primary tumor, more effective systemic treatment of
disseminated disease (clinical or subclinical), the existence of blood - brain
barrier for the majority of cytostatic drugs and the introduction of new
imaging techniques. Most patients who develop brain metastases have short time
survival. The treatment is used: steroids, surgery, radiation therapy and
symptomatic treatment. The choice of treatment depends on the age, general
condition of the patient, the number and location of metastatic lesions and the
severity of the underlying disease. The last decade has created new
possibilities for the treatment of metastatic tumors such as radiosurgery and
radiochemotherapy combination treatment with radiation
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