Brain metastases: what's new with an old problem?

Purpose of review To summarize developments in the management of brain metastases over the past decade. Recent findings A few randomized trials have been published during the past decade examining the use of whole brain radiotherapy (WBRT) and radiosurgery (SRS) boost versus WBRT alone. Other recent trials have been published examining the use of SRS alone versus SRS and WBRT. There continues to be neither a role for the routine use of chemotherapy (excluding patients with metastatic seminoma to brain) nor radiosensitizers in the management of patients with brain metastases. Summary The management options for selected patients with brain metastases today include steroids (to treat brain edema), anticonvulsants (to treat seizures), WBRT, surgery (for single brain metastasis) and radiosurgery (SRS), either alone or in combination. Survival, local metastasis control, overall brain control, and neurocognitive outcomes should influence management. New therapeutic areas of research for brain metastases include defining the role of conventional and novel chemotherapy and targeted agents, radiation sensitizers, and stem cell-associated therapies either alone or in combination with various forms of radiation, as well as decreasing radiation morbidities, using drugs or technology. Keywords brain, metastases, review INTRODUCTION The medical management for patients with brain metastases includes corticosteroids and/or anticonvulsants to alleviate symptoms; whole brain radiotherapy (WBRT) is the most commonly utilized treatment. New areas of research include defining the role of conventional chemotherapy and novel chemotherapy and targeted agents, radiation sensitizers, stem cell-associated therapies and methods, and agents to decrease cognitive morbidity. SYMPTOM MANAGEMENT Steroids and anticonvulsants are frequently used for symptom management such as increased intracranial pressure or seizures. The role of steroids to treat symptomatic brain edema has been reviewed systematically, and an evidence-based clinical guideline has been published [1&,2]. Recent guidelines for the use