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Vol 70, No 3 (2020)
Review article
Published online: 2020-06-16
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An update on the epidemiology, imaging and therapy of brain metastases

Maciej Mielczarek, Anna Kubica, Mateusz Szylberg, Karolina Zielińska, Jakub Przybył, Agata Sierzputowska, Marek Harat
DOI: 10.5603/NJO.2020.0024
·
Nowotwory. Journal of Oncology 2020;70(3):111-117.

open access

Vol 70, No 3 (2020)
Review article
Published online: 2020-06-16

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.

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Keywords

brain, cancer; metastasis; imaging; therapy; surgery; immunotherapy

About this article
Title

An update on the epidemiology, imaging and therapy of brain metastases

Journal

Nowotwory. Journal of Oncology

Issue

Vol 70, No 3 (2020)

Pages

111-117

Published online

2020-06-16

DOI

10.5603/NJO.2020.0024

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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