Since you were recently diagnosed with a brain tumor, ask your doctor these questions at your next visit.
1. What type of brain tumor do I have, and what is its grade?
2. What are the symptoms of brain cancer?
3. What part of my brain is affected by the tumor and what does this region of the brain do?
4. Will it be possible to surgically remove my tumor?
5. Will I need any other treatments such as chemotherapy or radiotherapy after surgery?
6. What are the possible side effects of these therapies?
Revised text on factors used to diagnose brain metastases to include diagnostic procedures, including contrast magnetic resonance imaging (MRI) of the brain.
Treatment Option Overview
Added text to state that external-beam radiation therapy using either 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy is considered an acceptable technique in radiation therapy delivery. Typically 2- to 3-cm margins on the MRI-based volumes to create the planning target volume are used. Dose escalation using radiosurgery has not improved outcomes.
Added Souhami et al. as reference 15.
Added Leptomeningeal carcinomatosis as a new subsection.
Added text to state that a phase III randomized trial compared adjuvant whole-brain radiation therapy (WBRT) with observation after surgery or radiosurgery for a limited number of brain metastases in patients with stable solid tumors. Added that health-related quality of life was improved in the observation-only arm compared with WBRT and patients in the observation arm had better mean scores in physical, role, and cognitive functioning at 9 months. Also added that In an exploratory analysis, statistically significant worse scores for bladder control, communication deficit, drowsiness, hair loss, motor dysfunction, leg weakness, appetite loss, constipation, nausea/vomiting, pain, and social functioning were observed in patients who underwent WBRT compared with those who underwent observation only (cited Soffietti et al. as reference 48 and level of evidence 1iiC).
Revised text to state that given this body of information, focal therapy plus WBRT or focal therapy alone, with close follow-up with serial MRIs and initiation of salvage therapy when clinically indicated, appear to be reasonsable treatment options.
Revised text to state that patients with multiple brain metastases may be treated with WBRT and that surgery is indicated to obtain tissue from a metastasis with an unknown primary tumor or to decompress a symptomatic dominant lesion causing significant mass effect. Added text to state that a meta-analysis of two trials found no statistically significant difference in overall survival (OS) between the WBRT plus stereotactic radiosurgery (SRS) and WBRT alone groups; patients in the WBRT plus SRS group had decreased local failure compared with patients who received WBRT alone. An unchanged or improved Karnofsky Performance Scale at 6 months was seen in 43% of patients in the combined therapy group versus only 28% in the WBRT group (cited Patil et al. as reference 49 and level of evidence 1iiDiii).