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Current approaches to the treatment of metastatic brain tumours

2014; Nature Portfolio; Volume: 11; Issue: 4 Linguagem: Inglês

10.1038/nrclinonc.2014.25

1759-4782

Taofeek K. Owonikoko, Jack L. Arbiser, Amelia Zelnak, Hui‐Kuo G. Shu, Hyunsuk Shim, Adam Robin, Steven N. Kalkanis, Timothy G. Whitsett, Bodour Salhia, Nhan L. Tran, Timothy C. Ryken, Michael K. Moore, Kathleen M. Egan, Jeffrey J. Olson,

Lung Cancer Treatments and Mutations

Brain metastasis is an important complication associated with a number of common primary cancers, including lung and breast cancers, and melanoma, and has major effects on patient morbidity and mortality. This Review discusses the advances in our understanding of the molecular biology of brain metastases, and how this knowledge has influenced the imaging, surgical, radiological and pharmaceutical approaches involved in the management of brain metastasis. Metastatic tumours involving the brain overshadow primary brain neoplasms in frequency and are an important complication in the overall management of many cancers. Importantly, advances are being made in understanding the molecular biology underlying the initial development and eventual proliferation of brain metastases. Surgery and radiation remain the cornerstones of the therapy for symptomatic lesions; however, image-based guidance is improving surgical technique to maximize the preservation of normal tissue, while more sophisticated approaches to radiation therapy are being used to minimize the long-standing concerns over the toxicity of whole-brain radiation protocols used in the past. Furthermore, the burgeoning knowledge of tumour biology has facilitated the entry of systemically administered therapies into the clinic. Responses to these targeted interventions have ranged from substantial toxicity with no control of disease to periods of useful tumour control with no decrement in performance status of the treated individual. This experience enables recognition of the limits of targeted therapy, but has also informed methods to optimize this approach. This Review focuses on the clinically relevant molecular biology of brain metastases, and summarizes the current applications of these data to imaging, surgery, radiation therapy, cytotoxic chemotherapy and targeted therapy.