Brainmetatases 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.
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.
Treatment options for brain metastases are: symptomatic and
specific therapy directed at the area of the tumor or tumors. To the first
treatment should antioedematous and anticonvulsants. Causal treatment includes:
surgical resection with or without radiotherapy of the whole brain (WBRT), an
independent method of WBRT, radiosurgery (SRS), SRS + WBRT, chemotherapy.
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