00:01
How do we treat brain metastasis?
Well, they're common.
00:04
There's been a lot of
studies and understanding
about how we should
treat these patients.
00:08
Brain metastasis are the most common
central nervous system malignancy,
with about over 160,000
new cases per year.
00:15
And there are two treatments
that I want you to think about.
00:19
The first is surgery
or a craniotomy.
00:22
Going in and taking out
a symptomatic lesion,
making a diagnosis,
and then sending the patient
to subsequent treatment.
00:30
The second is radiation therapy.
00:32
And we'll learn about multiple
different types of radiation,
including
stereotactic radiosurgery,
which you can see here
that really reduces the risk
of subsequent brain metastasis.
00:42
And we'll talk more about this
in the next few slides.
00:46
When do we think about surgery?
Well, surgery is really optimal
in three situations.
00:51
If there is a solitary, a single,
one single lesion,
we can go after it with surgery
and help that patient.
00:58
Lesions that are superficial,
tumors that are superficial,
are easy to access.
01:02
And then importantly,
those that are symptomatic
as a result of mass effect
that need decompression,
or management
of new patient symptoms.
01:11
There are times
when we worry about surgery.
01:14
Surgery for metastasis in the
posterior fossa is really important,
but those tumors
are at higher risk for seeding
the leptomeningeal space.
01:23
Postoperative radiation therapy
to the resection cavity
even after surgery
is common in patients.
01:29
So surgery may be
the start of treatment,
but often is not the end.
01:35
There are some reasons to do
a craniotomy, a surgery,
and some contraindications.
Some reason to worry about that.
01:40
Indications
or reasons to do surgery,
or if the patient
doesn't have a cancer diagnosis,
and that's the tissue that we need
to establish
the patient's diagnosis.
01:49
For large or symptomatic tumors,
and typically those are tumors that
are larger than three centimeters
are associated with midline shift
or mass effect around the brain.
01:59
And then recurrent brain metastases
that have previously been treated
with radiosurgery
or stereotactic radiation,
or radiation therapy,
and are higher risk
for subsequent radiation treatment.
02:08
There are also some times
where we wouldn't want
to do surgery.
02:11
Eloquent area
the are areas of the brain.
02:13
That just are not amenable
to surgical resection.
02:17
When a patient's health
is declining,
or when surgery would delay,
urgent need
for a good chemotherapy.