Diagnosis and management of brain metastases: an updated review from a radiation oncology perspective

Abstract

Brain metastasis are the most common intracranial malignancy in the adult population. Their incidence has increased dramatically over the last 20 years, as a result of the increasing number of cases stemming from lung and breast cancer together with the higher cancer survival rates due to diagnostic and therapeutic advances. More than 40% of cancer patients develop brain metastases during the course of their disease: specifically, they appear in 50% of patients with lung cancer, more than 25% of patients with breast cancer, and 20% of patients with melanoma. Diagnosis is made using different imaging approaches, such as computed tomography and magnetic resonance imaging, accompanied by clinical manifestations and a history of malignancy supporting the diagnosis of a brain metastasis. Current treatment options should be oriented to the patient’s current performance, the number of intracranial and extracranial lesions, and related factors. Although surgical resection and whole-brain radiotherapy have been standard treatments for many years, numerous treatment modalities have become more easily available and accepted worldwide, producing more favorable and reliable results. Among these is stereotactic radiosurgery, and the latest clinical trials support this treatment.

Keywords

Brain metastases / whole-brain radiation therapy / stereotactic radiosurgery / graded prognostic assessment

References

[1] Tabouret E,Carpentier A.Épidémiologie des métastases cérébrales et tropisme cérébral..Bull Cancer2013;100:57-62

[2] Schouten LJ,Huveneers HA.Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma..Cancer2002;94:2698-705

[3] Fidler IJ.The biology of brain metastasis: challenges for therapy..Cancer2015;21:284-93

[4] Conrad CA.Chemotherapy for metastatic tumors to the central nervous system..Curr Oncol Rep2001;3:490-4

[5] Guõmundsson KR.A survey of tumours of the central nervous system in Iceland during the 10-year period 1954-1963..Acta Neurologica Scandinavica1970;46:538-52

[6] Percy AK,Okazaki H.Neoplasms of the central nervous system. Epidemiologic considerations..Neurol1972;22:40e8

[7] Barnholtz-Sloan JS,Davis FG,Lai P.Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System..J Clin Oncol2004;22:2865-72

[8] Fox BD,Patel AJ,Rao G.Epidemiology of metastatic brain tumors..Neurosurg Clin N Am2011;22:1-6

[9] Schouten LJ,Huveneers HA.Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma..Cancer2002;94:2698-705

[10] Suki D.Sawaya R.The epidemiology of brain metastasis..Intracranial metastases: current management strategies.2004;Malden (MA)Blackwell20

[11] Posner JB.Brain metastases: 1995. A brief review..J Neurooncol1996;27:287-93

[12] Franchino F,Soffietti R.Mechanisms and therapy for cancer metastasis to the brain..Front Oncol2018;8:161 PMCID:PMC5976742

[13] Cooper JB,Tobias ME,Hillard V.Molecular sequence of events and signaling in brain metastases..Anticancer Res2018;38:1859-77

[14] Svokos KA,Toms SA.Molecular biology of brain metastasis..Int J Mol Sci2014;15:9519-30 PMCID:PMC4100107

[15] Wilhelm I,Fazakas C,Krizbai IA.Role of the blood-brain barrier in the formation of brain metastases..Int J Mol Sci2013;14:1383-411 PMCID:PMC3565326

[16] Winkler F.The brain metastatic niche..J Mol Med (Berl)2015;93:1213-20

[17] Hugen N,De Wilt JHW.Metastatic pattern in colorectal cancer is strongly influenced by histological subtype..Ann Oncol2014;25:651-7 PMCID:PMC4433523

[18] Beasley KD.The molecular pathobiology of metastasis to the brain: a review..Neurosurg Clin N Am2011;22:7-14

[19] Schellinger PD,Thron A.Diagnostic accuracy of MRI compared to CC in patients with brain metastases..J Neurooncol1999;44:275-81

[20] Kramer RA,Perlstein G.An approach to contrast enhancement in computed tomography of the brain..Radiology1975;116:641-7

[21] Ferrigno D.Cranial computed tomography as a part of the initial staging procedures for patients with non-small-cell lung cancer..Chest1994;106:1025-9

[22] Sze G,Johnson C.Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT..Am J Neuroradiol1990;11:785-91

[23] Hakyemez B,Gokalp G,Parlak M.Solitary metastases and high-grade gliomas: radiological differentiation by morphometric analysis and perfusion-weighted MRI..Clin Radiol2010;65:15-20

[24] Ishimaru H,Iwanaga S.Differentiation between high-grade glioma and metastatic brain tumor using single-voxel proton MR spectroscopy..Eur Radiol2001;11:1784-91

[25] Chiang IC,Lu CY,Lin WC.Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imagings..Neuroradiol2004;46:619-27

[26] Chuang MT,Tsai YS,Wang CK.Differentiating radiation-induced necrosis from recurrent brain tumor using MR perfusion and spectroscopy: a meta-analysis..PLoS One2016;11:e0141438 PMCID:PMC4712150

[27] Wang Q,Xu W,Zhang J.Role of magnetic resonance spectroscopy to differentiate high-grade gliomas from metastases..Tumour Biol2017;39:1010428317710030

[28] Usinskiene J,Bjørnerud A,Katsaros VK.Optimal differentiation of high- and low-grade glioma and metastasis: a meta-analysis of perfusion, diffusion, and spectroscopy metrics..Neuroradiology2016;58:339-50

[29] Fan G,Wu Z,Guo Y.In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases..Clin Radiol2004;59:77-85

[30] Al-Okaili RN,Wang S,Melhem ER.Advanced MR imaging techniques in the diagnosis of intraaxial brain tumors in adults..Radiographics.2006;26 Suppl 1:S173-89

[31] Horská A.Imaging of brain tumors: MR spectroscopy and metabolic imaging..Neuroimaging Clin N Am2010;20:293-310 PMCID:PMC2927327

[32] Verma A,Verma N,Ojha R.Magnetic resonance spectroscopy: Revisiting the biochemical and molecular milieu of brain tumors..BBA Clin2016;5:170-8 PMCID:PMC4845155

[33] Galicich JH,Melby JC.Use of dexamethasone in treatment of cerebral edema associated with brain tumors..Lancet1961;81:46-53

[34] Ryken TC,Robinson PD,Andrews DW.The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline..J Neurooncol2010;96:103-14 PMCID:PMC2808527

[35] Forster C,Golenhofen N,Kietz S.Occludin as direct target for glucocorticoid-induced improvement of blood–brain barrier properties in a murine in vitro system..J Physiol2005;565:475-86 PMCID:PMC1464527

[36] Chang SM,Ahluwalia M,Brastianos PK.Anticonvulsant prophylaxis and steroid use in adults with metastatic brain tumors: ASCO and SNO endorsement of the congress of neurological surgeons guidelines..J Clin Oncol2019;37:1130-5

[37] Perry J,Chambers A,Lloyd N.The use of prophylactic anticonvulsants in patients with brain tumours: a systematic review..Curr Oncol2006;13:222-9 PMCID:PMC3394608

[38] Furuse M,Itoh M,Yonemura S.Occludin: a novel integral membrane protein localizing at tight junctions..J Cell Biol1993;123:1777-88 PMCID:PMC2290891

[39] Maschio M,Gomellini S,Sperati F.Antiepileptics in brain metastases: safety, efficacy and impact on life expectancy..J Neurooncol2010;98:109-16

[40] Gaspar L,Rotman M,Phillips T.Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials..Int J Radiat Oncol Biol Phys1997;37:745-51

[41] Gaspar LE,Murray K.Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases..Int J Radiat Oncol Biol Phys2000;47:1001-6

[42] Sperduto PW,Roberge D,Shanley R.Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases..J Clin Oncol2012;30:419-25 PMCID:PMC3269967

[43] Villà S,Moretones C,Combescure C.Validation of the new graded prognostic assessment scale for brain metastases: a multicenter prospective study..Radiat Oncol2011;6:23 PMCID:PMC3058011

[44] Tsao MN,Wirth A,Danielson BL.Radiotherapeutic and surgical management for newly diagnosed brain metastases: an American society for radiation oncology evidence based guideline..Prac Radiat Oncol2012;2:210-25 PMCID:PMC3808749

[45] Chao JH,Nickson JJ.Roentgen-ray therapy of cerebral metastases..Cancer1954;7:682-9

[46] Marks LB,Jackson A,Constine LS.Use of normal tissue complication probability models in the clinic..Int J Radiat Oncol Biol Phys2010;76:S10-9 PMCID:PMC4041542

[47] Borgelt B,Kramer S,Chang CH.The palliation of brain metastases: Final results of the first two studies by the radiation therapy oncology group..Int J Radiat Oncol Biol Phys1980;6:1-9

[48] Gaspar LE,Murray K.Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases..Int J Radiat Oncol Biol Phys2000;47:1001-6

[49] Sperduto PW,Roberge D,Shanley R.Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases..J Clin Oncol2012;30:419-25 PMCID:PMC3269967

[50] Rades D,Dunst J,Veninga T.Comparison of short-course versus long-course whole-brain radiotherapy in the treatment of brain metastases..Strahlenther Onkol2008;184:30-5

[51] Andrews DW,Sperduto PW,Gaspar LE.Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial..Lancet2004;363:1665-72

[52] Aoyama H,Tago M,Toyoda T.Stereotactic radiosurgery plus whole-brain radiation therapy vs. stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial..JAMA2006;295:2483-91

[53] O’Beirn M,Meade S,Sawlani V.The expanding role of radiosurgery for brain metastases..Medicines (Basel)2018;5:E90 PMCID:PMC6165316

[54] David Roberge,Brown PD.Radiosurgery to the postoperative surgical cavity: who needs evidence?.Int J Radiation Oncol Biol Phys2012;83:486-93

[55] Flores BC,Timmerman RD.From patchell to brown: an evidence-based evolution of the role of radiotherapy on the management of brain metastases..World Neurosurg2016;85:10-4

[56] Patchell RA,Walsh JW,Maruyama Y.A randomized trial of surgery in the treatment of single metastases to the brain..N Engl J Med1990;322:494-500

[57] Patchell RA,Regine WF,Mohiuddin M.Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial..JAMA1998;280:1485-9

[58] Wang TJ,Qureshi YH,Isaacson SR.Outcomes of gamma knife radiosurgery, bi-modality & tri-modality treatment regimens for patients with one or multiple brain metastases: the Columbia University Medical Center experience..J Neurooncol2015;122:399-408

[59] Pirzkall A,Lohr F,Rhein B.Radiosurgery alone or in combination with whole-brain radiotherapy for brain metastases..J Clin Oncol1998;16:3563-9

[60] Brown PD,Ballman KV,Cerhan JH.Effect of radiosurgery alone vs. radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases,.JAMA2016;316:401-9 PMCID:PMC5313044

[61] Chang EL,Hess KR,Lang FF.Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial..Lancet Oncol2009;10:1037-44

[62] Yamamoto M,Shuto T,Higuchi Y.Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study..Lancet Oncol2014;15:387-95

[63] Shaw E,Souhami L,Kline R.Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05..Int J Radiation Oncol Biol Phys2000;47:291-8

[64] Riccardo Soffietti,Baumert B,Kinhult S.Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)..Neuro Oncol2017;19:162-74 PMCID:PMC5620494

[65] Minniti G,Scaringi C,Clarke E.Fractionated stereotactic radiosurgery for patients with brain metastases..J Neuro-Oncol2014;117:295-301

[66] Navarria P,Cozzi L,De Rose F.Hypo-fractionated stereotactic radiotherapy alone using volumetric modulated arc therapy for patients with single, large brain metastases unsuitable for surgical resection..Radiat Oncol2016;11:76 PMCID:PMC4890257

[67] Khan M,Liao G,Liang Y.Whole brain radiation therapy plus stereotactic radiosurgery in the treatment of brain metastases leading to improved survival in patients with favorable prognostic factors..Front Oncol2019;9:205 PMCID:PMC6449627

[68] Soliman H,Angelov L,Chiang VLS.Consensus contouring guidelines for post-operative completely resected cavity stereotactic radiosurgery (SRS) for brain metastases..Int J Radiat Oncol Biol Phys2017;100:436-42

[69] Makale M,Hattangadi-Gluth J.Brain irradiation and long-term cognitive disability: Current concepts..Nat Rev Neurol2017;13:52-64 PMCID:PMC5805381

[70] Wu PH,Pinnix C,Tailor R.Radiation induces acute alterations in neuronal function..PLoS One2012;7:e37677 PMCID:PMC3360766

[71] Gondi V,Tome WA,Corn B.Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial..J Clin Oncol2014;32:3810-6 PMCID:PMC4239303