| Abstrakt: |
Simple Summary: The brain is a common site of metastases from cancer. Approximately 10% of all patients develop brain metastasis during their illness. Brain metastasis used to be frequently associated with significant morbidity and short survival, measured in months. However, with advances in treatment, a significant number of patients can now expect to live for several years, with a better quality of life. We reviewed the literature published over the last 50 years, to identify patterns of care of patients diagnosed with brain metastases. Techniques such as whole brain radiotherapy are used sparingly only. A more in-depth knowledge about the cancers, and advances in radiotherapy techniques, such as focused radiation to the site of metastases, and targeted therapy which crosses the barrier between the blood and the brain have revolutionized the care, especially in patients with lung cancer, breast cancer, and melanoma. This type of literature review not only helps to summarize the evolution of clinical practice, but also helps to identify the current trends for researchers. A systematic review of the published literature was conducted to analyze the management evolution of brain metastases from different cancers. Using the keywords "brain metastasis", "brain metastases", "CNS metastasis", "CNS metastases", "phase III" AND/OR "Randomized Controlled Trial" (RCT), relevant articles were searched for on the SCOPUS database. A total of 1986 articles were retrieved, published over a 45-year period (1977–2022). Relevant articles were defined as clinical studies describing the treatment or prevention of brain metastases from any cancer. Articles on imaging, quality of life, cognitive impairment after treatment, or primary brain tumors were excluded. After a secondary analysis, reviewing the abstracts and/or full texts, 724 articles were found to be relevant. Publications significantly increased in the last 10 years. A total of 252 articles (34.8%) were published in 12 core journals, receiving 50% of the citations. The number of publications in Frontiers in Oncology, BMC Cancer, and Radiotherapy and Oncology have increased considerably over the last few years. There were 111 randomized controlled trials, 128 review articles, and 63 meta-analyses. Most randomized trials reported on brain metastases management from unselected tumors (49), lung cancer (47), or breast cancer (11). In the last 5 years (2017 to 2022), management of brain metastasis has moved on from WBRT, the use of chemotherapy, and radio-sensitization to three directions. First, Radiosurgery or Radiotherapy (SRS/SRT), or hippocampal-sparing WBRT is employed to reduce radiation toxicity. Second, it has moved to the use of novel agents, such as tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) and third, to the use of molecularly directed therapy such as TKIs, in asymptomatic low volume metastasis, obviating the need for WBRT. [ABSTRACT FROM AUTHOR] |
