A multidisciplinary management algorithm for brain metastases.
Alexander RamosAlexandra M Giantini LarsenSusan C PannulloAndrew BrandmaierJonathan KniselyRajiv MaggeJessica A WilcoxAnna C PavlickBarbara MaDavid PisapiaHani AshamallaRohan R RamakrishnaPublished in: Neuro-oncology advances (2022)
The incidence of brain metastases continues to present a management issue despite the advent of improved systemic control and overall survival. While the management of oligometastatic disease (ie, 1-4 brain metastases) with surgery and radiation has become fairly straightforward in the era of radiosurgery, the management of patients with multiple metastatic brain lesions can be challenging. Here we review the available evidence and provide a multidisciplinary management algorithm for brain metastases that incorporates the latest advances in surgery, radiation therapy, and systemic therapy while taking into account the latest in precision medicine-guided therapies. In particular, we argue that whole-brain radiation therapy can likely be omitted in most patients as up-front therapy.
Keyphrases
- brain metastases
- small cell lung cancer
- radiation therapy
- minimally invasive
- deep learning
- end stage renal disease
- machine learning
- chronic kidney disease
- radiation induced
- white matter
- mesenchymal stem cells
- multiple sclerosis
- newly diagnosed
- blood brain barrier
- acute coronary syndrome
- prognostic factors
- brain injury
- resting state
- quality improvement
- cell therapy
- drug induced