By: James I. Ausman, MD, PhD
Brain Metastasis is often regarded with hopelessness, but new advances in Diagnosis and Treatment have changed that opinion.
Brain metastasis occurs in up to 50% of patients with cancer. As new systemic treatments prolong life, brain metastases become more common. Quality of Life (QOL) is the most important goal of treatment.
Often a metastasis to the brain is silent and is found on routine screening after the primary is found. Symptoms of weakness of an arm or leg, speech or visual disturbance, or balance problems are the most common from larger lesions or smaller metastasis located in critical areas. Headache, nausea and vomiting are non-specific symptoms of increased intracranial pressure. Metastases producing symptoms are considered for surgical treatment. Silent metastases are best considered for Stereotactic Radiation Treatment (SRT).
The best imaging modality is contrast enhanced MR, as CT with contrast can underestimate the number of lesions.
Treatment decisions include:
All cancers can metastasize to the brain. With the success of modern therapy, brain metastases are becoming more frequent. The most common tumors to metastasize are lung, breast, renal, and colon cancers, and melanoma.
Patients with leptomeningeal carcinomatosis can be treated with a combination of therapies, including shunting for hydrocephalus or reservoir implantation for intrathecal treatment. Given the many options now available to these patients with brain metastases, a discussion by the referring doctor or the patient with the neurosurgeon is valuable to be able to review all the options now available.
Dr. Ausman is formerly Head of Neurosurgery at Henry Ford Hospital in Detroit, Michigan and at the University of Illinois at Chicago. He is presently Professor of Neurosurgery at UCLA and Harbor–UCLA Medical Centers. He is Editor-in-Chief of Surgical Neurology International, a Free Internet journal of Neurosurgery with the largest circulation in the world, read in 227 countries. (www.sni.global). He can be reached at Desert Spine and Neurosurgical Institute (760) 346- 8058 or at firstname.lastname@example.org. He is also a member of Desert Doctors. For more information visit DesertDoctors.org or call (760) 232-4646.