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1、CurrNeurolNeurosciRep(2015)15:518DOI10.1007/s11910-014-0518-9NEURO-ONCOLOGY(LEABREY,SECTIONEDITOR)SystemicTherapyofBrainMetastasesHarryC.Brastianos&DanielP.Cahill&PriscillaK.Brastianos#SpringerScience+BusinessMediaNewYork2014AbstractBrainmetastasesareacommoncom
2、plicationofKeywordsBrainmetastases.Targetedtherapies.cancerandcontinuetobeassociatedwithapoorprognosis.Immunotherapy.ChemotherapyManagementofbrainmetastasestypicallyrequiresamultidis-ciplinaryapproachwhichmayincludewhole-brainradiationtherapy,stereotacticradios
3、urgery,surgery,andsystemicther-Introductionapy.Historically,theuseofsystemictherapyinbrainmetas-taseshasbeenchallengingbecauseoftheresistancetocon-Metastasestothecentralnervoussystemareadevastatingandventionalchemotherapiessecondarytotheblood-brainbarriercommon
4、complicationofcancer.Fromautopsystudies,brainandanoftenheavilypre-treatedpatientpopulation,andmetastaseshavebeenreportedin10–25%ofpatientswiththepaucityofwell-conductedrandomizedtrialsinthesecancer[1–3].Themostcommonprimarycancerstometasta-heterogeneouspatientp
5、opulations.Neweragents,in-sizetothebrainarelungandbreastcancers,andmelanomacludingimmunotherapyandtargetedtherapies,are[1–4].Anatomically,thedistributionofbrainmetastasesre-playingincreasinglyimportantrolesintheup-frontflectvascularflowandthevolumeofbrainparenc
6、hyma:80%managementofbrainmetastases.Inthisoverview,wepresentwithinthecerebralhemispheres,15%withinthereviewrecentadvancesinsystemictherapiesforbraincerebellarhemispheres,and5%withinthebrainstem[5,2].metastasesandtheevidencesupportingtheiruseinthisHistorically,s
7、urvivalhasbeendismal,typicallyinthepatientpopulation.rangeof2to4months,buttheseresultsarechangingassystemictherapiesimprove.ArecursivepartitioninganalysisDanielP.CahillandPriscillaK.Brastianoscontributedequallytoof1200patientstreatedinthreelargeRadiationTherapy
8、thiswork.Oncology(RTOG)trials,youngerpatients(<65yearsofThisarticleispartoftheTopicalCollectiononNeuro-Oncologyage)withagoodperformancestatus(Karnofskyperformancestatusofatl
