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An update on the epidemiology, imaging and therapy of brain metastases
Affiliations- 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
open access
Abstract
Introduction.The incidence of brain metastases (BM) is rapidly increasing, with most cases occurring in patients aged 50–80 years and in 10–40% of patients with systemic neoplastic disease. The Graded Prognostic Assessment (GPA) is the most impartial prognostic method, according to which the average survival rate of patients with brain metastases is only 7.18 months.
Purpose.To present a systematic review of the currently available evidence-based literature on the epidemiology, diagnosis, and treatment of BM.
Methods.The authors searched PubMed up to March 2020 using the phrases “brain metastases”, “brain metastasis surgery”, and “brain metastases treatment”, which returned 65 citations.
Conclusions.The choice of imaging and therapy for brain metastases remains a significant clinical problem. MRI, including T1, T1 + C, T2, FLAIR, and SWI sequences, is the most sensitive method for solitary BM detection, while other techniques such as spectroscopy, perfusion imaging, or fractional anisotropy contribute to diagnosis precision and neurological deficit avoidance in cases eligible for surgery. According to current treatment algorithms, three main methods are used to manage BM: surgery, chemotherapy, and radiotherapy, depending on the expected effect and the patient’s clinical condition. Surgery is most often used, offering neurological deficit remission in 60 to 90% of patients. Most chemotherapeutics do not cross the blood-brain barrier, so immunotherapy with antibodies such as pembrolizumab and ipilimumab, as well as antineoplastic vaccines, are a promising therapeutic prospect.
Abstract
Introduction.The incidence of brain metastases (BM) is rapidly increasing, with most cases occurring in patients aged 50–80 years and in 10–40% of patients with systemic neoplastic disease. The Graded Prognostic Assessment (GPA) is the most impartial prognostic method, according to which the average survival rate of patients with brain metastases is only 7.18 months.
Purpose.To present a systematic review of the currently available evidence-based literature on the epidemiology, diagnosis, and treatment of BM.
Methods.The authors searched PubMed up to March 2020 using the phrases “brain metastases”, “brain metastasis surgery”, and “brain metastases treatment”, which returned 65 citations.
Conclusions.The choice of imaging and therapy for brain metastases remains a significant clinical problem. MRI, including T1, T1 + C, T2, FLAIR, and SWI sequences, is the most sensitive method for solitary BM detection, while other techniques such as spectroscopy, perfusion imaging, or fractional anisotropy contribute to diagnosis precision and neurological deficit avoidance in cases eligible for surgery. According to current treatment algorithms, three main methods are used to manage BM: surgery, chemotherapy, and radiotherapy, depending on the expected effect and the patient’s clinical condition. Surgery is most often used, offering neurological deficit remission in 60 to 90% of patients. Most chemotherapeutics do not cross the blood-brain barrier, so immunotherapy with antibodies such as pembrolizumab and ipilimumab, as well as antineoplastic vaccines, are a promising therapeutic prospect.
Keywords
brain, cancer; metastasis; imaging; therapy; surgery; immunotherapy
About this articleTitle
An update on the epidemiology, imaging and therapy of brain metastases
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
111-117
Published online
2020-06-16
Page views
1139
Article views/downloads
759
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2020;70(3):111-117.
Keywords
brain
cancer
metastasis
imaging
therapy
surgery
immunotherapy
Authors
Maciej Mielczarek
Anna Kubica
Mateusz Szylberg
Karolina Zielińska
Jakub Przybył
Agata Sierzputowska
Marek Harat
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