Current approaches to the treatment of metastatic brain tumors
Abstract
Background/Aim. About 10% of patients diagnosed with systemic cancer had brain metastases in the central nervous system. Patients with diseased lungs, breasts, urinary and digestive tract, as well as melanoma of the skin, are increasingly treated by neurosurgeons due to their dissemination and creation of secondary deposits in the brain. The aim of the study was to assess the efficacy of treatment modalities for patients with brain metastasis according to their type – solitary or multiple, and also to the primary cancer site. Methods. The retrospective study was performed at the Clinic for Neurosurgery and the Clinic for Oncology from 2018 to 2020. One hundred and eleven patients with solitary changes in the brain and 122 patients with multiple changes were examined. Results. It was found that multiple metastases were more common in primary lung cancer, while single metastases were more common in adenocarcinoma. However, patients with primary adenocarcinoma died in a significantly higher number. Conclusion. Surgery and radiation remain the cornerstone of therapy for symptomatic lesions. We should strive to improve surgical techniques in the direction of less damage to the surrounding healthy tissue. Radiosurgery, as well as whole brain radiotherapy, remains the basic form in the treatment of multiple metastases.
References
1. Patchell RA. Metastatic brain tumors. Neurol Clin 1995; 13(4): 915‒25.
2. Boyle P. Breast cancer control: signs of progress, but more work required. Breast 2005; 14(6): 429‒38.
3. Parkin DM, Fernández LM. Use of statistics to assess the global burden of breast cancer. Breast J 2006; 12 Suppl 1: S70‒80.
4. Al-Shamy G, Sawaya R. Management of brain metastases: the indispensable role of surgery. J Neurooncol 2009; 92(3): 275‒82.
5. Owonikoko TK, Arbiser J, Zelnak A, Shu HK, Shim H, Robin AM, et al. Current approaches to the treatment of metastatic brain tumours. Nat Rev Clin Oncol 2014; 11(4): 203‒22.
6. Ellert-Mikllasyewska A, Polesyak K, Pasierbinska M, Kaminska B. Integrin Signalinging Glioma Pathogenesis: Int J Mol Sci 2020; 21(3): 888.
7. Aslan K, Gunbey HP, Tomak L, Incesu L. Multiparametric MRI in differentiating solitary brain metastasis from high-grade glioma: diagnostic value of the combined use of diffusion-weighted imaging, dynamic susceptibility contrast imaging, and magnetic resonance spectroscopy parameters. Neurol Neurochir Pol 2019; 53(3): 227‒37.
8. Tas F. Metastatic behavior in melanoma: timing, pattern, survival, and influencing factors. J Oncol 2012; 2012: 647684.
9. Amir Z, Luker KA, Neary D Cancer survivors' views of work 3 years post diagnosis: A UK perspective6. Eur J Oncol Nurs Soc 2008; 12(3): 190‒7.
10. Bafaloukos D, Gogas H. The treatment of brain metastases in melanoma patients. Cancer Treat Rev 2004; 30(6): 515‒20.
11. Shu HK, Sneed PK, Shiau CY, McDermott MW, Lamborn KR, Park E, et al. Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases. Cancer J Sci Am 1996; 2(6): 335‒42.
12. Wang K, Pan L, Che X, Lou M. Gamma knife surgery-induced ependymoma after the treatment of meningioma – a case report. Neurol Neurochir Pol 2012; 46(3): 294‒6.
13. Shulman LN, Willett W, Sievers A, Knaul FM. Breast cancer in developing countries: opportunities for improved survival. J Oncol 2010; 2010: 595167.
14. Soffietti R, Rudā R, Mutani R. Management of brain metastases. J Neurol 2002; 249(10): 1357‒69.
15. Hall WA, Djalilian HR, Nussbaum ES, Cho KH. Long-term survival with metastatic cancer to the brain. Med Oncol 2000; 17(4): 279‒86.
16. Scoccianti S, Ricardi U. Treatment of brain metastases: review of phase III randomized controlled trials. Radiother Oncol 2012; 102(2): 168‒79.
17. Gates M, Alsaidi M, Kalkanis S. Surgical treatment of solitary brain metastases. Prog Neurol Surg 2012; 25: 74‒81.
18. Kanner AA, Bokstein F, Blumenthal DT, Ram Z. Surgical therapies in brain metastasis. Semin Oncol 2007; 34(3): 197‒205.
19. Kuo T, Recht L. Optimizing therapy for patients with brain metastases. Semin Oncol 2006; 33(3): 299‒306.
20. Kocher M, Maarouf M, Bendel M, Voges J, Müller RP, Sturm V. Linac radiosurgery versus whole brain radiotherapy for brain metastases. A survival comparison based on the RTOG recursive partitioning analysis. Strahlenther Onkol 2004; 180(5): 263‒7.
21. Métellus P, Tallet A, Dhermain F, Reyns N, Carpentier A, Spano JP, et al. Global brain metastases management strategy: a multidisciplinary-based approach. Cancer Radiother 2015; 19(1): 61‒5. (French)
22. Hoffman R, Sneed PK, McDermott MW, Chang S, Lamborn KR, Park E, et al. Radiosurgery for brain metastases from primary lung carcinoma. Cancer J 2001; 7(2): 121‒31.
23. Briasoulis E, Kalofonos H, Bafaloukos D, Samantas E, Fountzilas G, Xiros N, et al. Carboplatin plus paclitaxel in unknown primary carcinoma: a phase II Hellenic Cooperative Oncology Group Study. J Clin Oncol 2000; 18(17): 3101‒7.
24. Sahgal A, Soliman H, Larson DA. Whole-brain radiation therapy of brain metastasis. Prog Neurol Surg 2012; 25: 82‒95.
25. Oura K, Tadokoro T, Fujihara S, Morishita A, Chiyo T, Samukawa E, et al. Telmisartan inhibits hepatocellular carcinoma cell proliferation in vitro by inducing cell cycle arrest. Oncol Rep 2017; 38(5): 2825‒35.
26. Sharma K, Costas A, Shulman LN, Meara JG. A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation. J Oncol 2012; 2012: 121873.
27. Den RB, Andrews DW. Combined role of whole-brain radiation therapy and radiosurgery for the treatment of brain metastasis. Prog Neurol Surg 2012; 25: 228‒35.