Metastatic Brain Tumors
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Treatment for patients with a single metastasis:
Treatment Options for Newly Diagnosed Childhood Craniopharyngioma
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ Editorial Boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) There is no consensus as to the optimal treatment of newly diagnosed craniopharyngioma. Little data exists to compare the different modalities in terms of recurrence rate or quality...
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About 10% to 20% of patients with cancer will have a single brain metastasis. The extent of extracranial disease can influence subsequent treatment of the brain lesions. In the presence of extensive systemic disease, surgery provides little benefit for overall survival (OS). In patients with minimal extracranial disease, combined modality treatment should be used. Treatment is usually surgical resection followed by radiation therapy. In a randomized trial, this approach showed that patients who received whole-brain radiation therapy (WBRT) after resection were much less likely to fail in the brain and were significantly less likely to die of neurological causes, but OS was the same.[1]
A Radiation Therapy Oncology Group (RTOG) study (RTOG-9508) randomized patients with one to three metastases with a maximum diameter of 4 cm to WBRT with or without a stereotactic boost. The combined-treatment group had a survival advantage of 2½ months in patients with a single metastasis but not in patients with multiple lesions. Local control was significantly better in all groups with combined therapy.[2][Level of evidence: 1iiDii]
Treatment for patients with multiple metastases:
Patients with multiple brain metastases are treated with WBRT. Surgery is reserved only for large symptomatic lesions or for obtaining tissue with an unknown primary. Stereotactic radiation surgery in combination with WBRT has been assessed and has been shown to give good local control, but median survival was not affected. Survival was determined by the extent of extracranial disease.[3] Stereotactic radiosurgery as a sole modality has been used; however, no randomized studies comparing that modality with a combined modality treatment have been done to evaluate the effect on survival.[4] An RTOG study randomized patients with one to three metastases with a maximum diameter of 4 cm to WBRT with or without a stereotactic boost. The combined-treatment group had a survival advantage of 2 1/2 months in patients with a single metastasis but not in patients with multiple lesions. Local control was significantly better in all groups with combined therapy.[2][Level of evidence: 1iiDii]
(Refer to the PDQ summaries on Breast Cancer Treatment; Colon Cancer Treatment; Non-Small Cell Lung Cancer Treatment; Small Cell Lung Cancer Treatment; and Testicular Cancer Treatment for more information.)
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with adult brain tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
WebMD Public Information from the National Cancer Institute
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