Brain metastasis as complication of systemic cancers

Brain metastases occur in up to 40% of patients with cancer and their frequency has increased over time. Lung, breast and melanoma are the most common sources of brain metastases, and in 10–15% of patients the primary site remains unknown. Contrast-enhanced MRI is the gold standard for the diagnosis. Subgroups of patients with different prognosis have been identified (RPA and GPA classifications). Symptomatic therapy includes corticosteroids and anticonvulsants. Complete surgical resection allows for relief of intracranial hypertension, seizures and focal neurological deficits. Stereotatic radiosurgery, alone or in conjunction with WBRT, yields results which are comparable to those reported after surgery followed by WBRT. WBRT after surgery or radiosurgery is increasingly omitted. The response rate of brain metastases to chemotherapy is similar to the response rate of the primary tumor and extracranial metastases. Targeted agents in specific molecular subgroups are emerging.