BRAIN METASTATIC LESIONS

Objective: To describe current concepts in the diagnosis and treatment of brain metastases. Results: More than 25% of all autopsy-proven bra in metastases have a pulmonary source. Most brain metastases manifest with a combination of focal and generalized symptoms and signs. Typica lly, patients have subacute, progressive symptoms. In most situations, a computed tomographic scan of the head provides sufficient neuroimag ing and allows one to monitor the effects of therapy. Magnetic resonan ce imaging has become increasingly useful in the diagnosis and managem ent of brain metastases. It can detect computed tomographic occult met astases, identify associated leptomeningeal disease, and reveal early therapeutic complications. Conclusion: Treatment options for patients with brain metastases include corticosteroids, whole-brain radiation t herapy (WBRT), surgical intervention, stereotactic radiosurgical techn iques, and chemotherapy. Corticosteroids produce prompt improvement in most patients; however, prolonged use is associated with considerable risks. For most patients, WBRT is the preferred treatment. Nonetheles s, it has associated nonneurologic and neurologic complications, some of which are serious. In patients with a single metastasis, surgical r emoval should be considered. Recent studies have suggested that resect ion of a single metastatic lesion followed by radiation therapy offers better survival than does radiation therapy alone. The subsequent adm inistration of WBRT after radiosurgical treatment has become standard practice. The role of chemotherapy is uncertain.