Summary and Further Reading

Chapter 8 - Management of CNS Metastases


  • CNS metastases are frequent and associated with high morbidity and mortality
  • CNS metastases are most common in lung cancer, breast cancer and melanoma patients
  • The incidence of CNS metastases is increasing
  • The prognosis of CNS metastasis patients is limited, but long-term survivors exist
  • The main prognostic factors are patient age, Karnofsky Performance Status, number of brain metastases and status of extracranial disease
  • Established treatments include neurosurgical resection, RT (including stereotactic radiosurgery and WBRT), and supportive care measures
  • Targeted therapies are emerging as useful treatment options in selected CNS metastasis patients
  • Neoplastic meningiosis is most common in patients with lung cancer, breast cancer and haematological neoplasms
  • The main treatment options for neoplastic meningiosis are RT, systemic or intrathecal ChT and supportive care

Further Reading

Bachelot T, Romieu G, Campone M, et al. Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. Lancet Oncol 2013; 14:64–71.

Berghoff AS, Bartsch R, Wöhrer A, et al. Predictive molecular markers in metastases to the central nervous system: recent advances and future avenues. Acta Neuropathol 2014; 128:879–891.

Kienast Y, von Baumgarten L, Fuhrmann M, et al. Real-time imaging reveals the single steps of brain metastasis formation. Nat Med 2010; 16:116–122.

Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 2011; 29:134–141.

Le Rhun E, Weller M, Brandsma D, et al. EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours. Ann Oncol 2017; 28(Suppl 4):iv84–iv99.

Lin NU, Lee EQ, Aoyama H, et al; Response Assessment in Neuro-Oncology (RANO) group. Challenges relating to solid tumour brain metastases in clinical trials, part 1: patient population, response, and progression. A report from the RANO group. Lancet Oncol 2013; 14:e396–e406.

Lin NU, Wefel JS, Lee EQ, et al; Response Assessment in Neuro-Oncology (RANO) group. Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group. Lancet Oncol 2013; 14:e407–e416.

Mehta MP, Paleologos NA, Mikkelsen T, et al. The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2010; 96:71–83.

Owonikoko TK, Arbiser J, Zelnak A, et al. Current approaches to the treatment of metastatic brain tumours. Nat Rev Clin Oncol 2014; 4:203–222.

Preusser M, Caper D, Ilhan-Mutlu A, et al. Brain metastases: pathobiology and emerging targeted therapies. Acta Neuropathol 2012; 123:205–222.

Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 2012; 30:419–425.

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Last update: 18 September 2017