‘First thing we need to do is to eliminate the nihilism while managing patients
Brain metastasis is a common clinical presentation in advanced carcinoma lung, breast cancer and others diseases. As the systemic treatment (chemotherapy) is improving (increase in survival), there are many more patients presenting with brain metastasis. Brain metastasis is considered ‘not curative’ and only a small proportion of patient survives more than 2 years after diagnosis. However, with advent of modern neurosurgical technologies, radiation therapy techniques and systemic therapy with higher penetration to brain tissue (blood brain barrier) the prognosis is looking slightly brighter. The main emphasis in last few years is on preservation quality of life and neurological functions.
In clinical practice, brain metastasis in almost 8 to 10 times more common than primary brain tumors. Hence, burden of patients with brain metastasis is huge.
Prognosis in brain metastasis depends upon:
There is recursive portioning analysis (RPA) classes to define prognosis in brain metastasis:
Solitary (single) brain metastasis
Single brain metastasis with controlled primary has relatively better prognosis and should be treated aggressively. Usual treatment is surgery if tumour is in assessable non-eloquent area of brain. Surgery will immediately relief the pressure effect and has improvement in symptoms.
Main advantages of radiosurgery in brain metastasis are:
There are randomized evidences that surgery or radiosurgery improves survival significantly compared with radiation therapy alone. In patients with 1 to 3 brain metastasis with controlled primary radiosurgery / surgery improves survival.
Prospective studies in larger/ multiple tumours treated with radiosurgery (CyberKnife):
Multiple brain metastases
Summary: Brain metastasis