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Cerebral metastases—a therapeutic update

Nature Clinical Practice Neurology volume 2, pages 426–436 (2006)Cite this article

Abstract

Cerebral metastases remain a common complication among patients with cancer. Historically, whole-brain radiotherapy has remained the standard of care, with surgery being reserved for selected cases. Recent advances have changed our practice, however. In particular, stereotactic radiosurgery has emerged as a vital treatment modality for this disease. In addition, chemotherapy, including temozolomide, topoisomerase inhibitors and antimetabolites, and treatment sensitizers, such as efaproxiral and motexafin gadolinium, are actively being assessed in clinical trials, and are likely to play an increasing role in the management of cerebral metastases in the future. Nonetheless, many uncertainties remain, such as the optimal combination and timing of therapeutics. As the arsenal of therapeutics expands, it will be increasingly important to select appropriate patients for a particular treatment paradigm. Understanding the efficacy and toxicity of treatment is essential to this task.

Key Points

  • The debate continues on the role of focal therapies in the management of cerebral metastases; in particular, the routine use of whole-brain radiotherapy is being questioned

  • Chemotherapy is emerging as a potential therapeutic strategy for cerebral metastases

  • Treatment sensitizers to enhance the response to therapies administered concomitantly are being carefully studied

  • Treatment of patients with cerebral metastases needs to be based on both clinical and tumor factors

  • Despite advances in our therapeutic arsenal against cerebral metastases, the impact on survival has been marginal, as most patients succumb to their systemic disease

  • Neurocognitive and quality-of-life endpoints must be incorporated into future studies of patients with cerebral metastases

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Authors and Affiliations

  1. assistant professor of neurology, neurosurgery and medicine in the Dardinger Neuro-Oncology Center at The Ohio State University, Columbus, OH, USA

    Robert Cavaliere

  2. Co-Director and an associate professor of neurology, neurosurgery and medicine at the University of Virginia Neuro-Oncology Center, Charlottesville, VA, USA

    David Schiff

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  1. Robert Cavaliere
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Correspondence to David Schiff.

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Competing interests

D Schiff has occasionally served as a consultant or lectured for Schering-Plough regarding the use of temozolomide in malignant gliomas. R Cavaliere declared he has no competing interests.

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Cavaliere, R., Schiff, D. Cerebral metastases—a therapeutic update. Nat Rev Neurol 2, 426–436 (2006). https://doi.org/10.1038/ncpneuro0263

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