Brain metastases have a poor prognosis and can be managed by various treatment methods. Methods such as chemotherapy, surgery, radiotherapy and immunotherapy are used for reducing the size of tumor and prolong the life of the patients.
What Is The Best Treatment For Brain Metastases?
Like as for other cancer treatments, there is no best treatment for brain metastases. The treatment depends upon the size and location of the tumor. The combination of various treatment strategies works best for the patient. This involves the use of radiotherapy, surgery and chemotherapy although chemotherapy is not normally used, but can be used in cases when the tumor is susceptible to chemotherapeutic drugs. Surgery is done to remove the maximum amount of tumor followed by radiotherapy for killing the remaining tumor cells. Thus, the best treatment is the combination of various treatments in appropriate ratios and intensity.[1]
The prognosis of the brain metastases is not significantly favorable as the cancer, which is metastasized to brain is also be metastasized to other parts of the body. Further, the prognosis also depends upon the site and size of the tumor and extent of the vital processes impacted due to tumor.[2] Thus, the treatment is generally directed to palliative care, which is usually to improve the quality of life and to prolong the life of patients. However, in some cases the curative treatment is also tried. Following are the treatment options available to the patients suffering from brain metastases:
Radiotherapy. Radiotherapy is an important treatment approach for the management of brain metastases. Radiotherapy includes various processes; the requirement depends upon the condition and age of the patient. Radiotherapy stops or slower the growth of tumor. Radiotherapy involves whole brain radiation therapy and stereotactic radiosurgery. Whole-brain radiotherapy is the conventional method for radiotherapy in which the whole brain is irradiated. This type of irradiation does not differ between the cancerous and the healthy cells, thus having both short term and long term side effects. Another type of radiotherapy which is devoid of the disadvantage of whole-brain radiation is stereotactic technologies, which only destroys the cancerous cells and spare the healthy cells.
Surgery. Surgery for brain metastases is generally accompanied with the radiotherapy. Radiotherapy stops or slow the growth of tumor cells and shrink the size of tumor, while surgery is needed to remove the remaining tumor. The main disadvantage of the brain surgery for tumor is many a times, the site of tumor is almost inaccessible to the surgeon. Although it is the most effective method of treatment as it involves the removal of tumor but many-a-times, removal of complete tumor is not possible.[3]
Chemotherapy. Chemotherapy drugs are used to kill the cancer cells. Although, this strategy may work well in case of primary tumor in the brain but can also be used for brain metastases. Data does not demonstrate any safety or efficacy of the chemotherapy in brain metastases as often these drugs are not able to achieve the minimum effective concentration in the brain. The reason being these drugs are not able to cross blood brain barrier. However, some tumors are susceptible to chemotherapy drugs. Chemotherapy is generally used to treat the extracranial tumor sites, which are the primary site for tumor generation.[4]
Immunotherapy. Immunotherapy and targeted therapies are the excellent treatment options, which treat the brain metastases effectively with lesser side effects. Immunotherapy is effective in various brain metastases in which the prior treatment is not done, and the tumor is relatively asymptomatic. Many drugs such as pembrolizumab, nivolumab and ipilimumab are under the clinical trial for their use in brain metastases.[5]
Supportive Treatment. Supportive treatment is required for managing the symptoms occurring due to brain tumor. The symptoms may be headache or vomiting or decline in cognitive dysfunction. For improving these symptoms, corticosteroid therapy is recommended. The patients with brain metastases also experience epilepsy. Anticonvulsant drugs are used to manage epilepsy.[6] The type of supportive treatment depends upon the site of tumor and the extent of its effect on the involved organ.
Conclusion
The best treatment for managing the brain metastases is to use the combination of various methods. Generally, surgery and radiotherapy are used for treating brain metastases. Immunotherapy is also an excellent option for treating brain metastases.
- https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140#:~:text=Treatment%20options%20for%20people%20with,drug%20treatments%20for%20brain%20metastases.
- https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/brain-metastases-intracranial-tumor/#:~:text=Prognosis,activity%20of%20the%20primary%20tumor.
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/radiation-therapy-for-metastatic-brain-tumor-3-things-you-should-know
- https://www.hindawi.com/journals/crionm/2015/620582/
- https://theoncologist.onlinelibrary.wiley.com/doi/10.1002/onco.13575
- https://www.webmd.com/epilepsy/medications-treat-seizures#:~:text=Other%20drugs%20used%20for%20seizures,%2C%20and%20vigabatrin%20(Sabril).
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