For the practicing medical or neuro-oncologist, the treatment approach would currently not change, given that systemic therapy should be started as soon as the diagnosis of PCNSL is made and the patient is stable from a neurosurgical perspective. In most cases, one would not refer the patient back to the surgeon for additional debulking.
Relatively few patients with primary diffuse large B-cell lymphoma (PCNSL) will have tumors that are amenable to resection. In the absence of the highest quality data, at least it is good to know that in the modern era, patients with PCNSL are probably not harmed by judicious tumor resection.
Although the current standard treatment for patients with locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision, concerns have been raised over the functional sequelae and possible overtreatment of rectal cancer patients.
Rectal cancer management is becoming increasingly complex. There is increasing recognition of the potential to avoid routine chemoradiotherapy, as excellent results can be achieved with a more selective approach.
Making appropriate treatment decisions for older adults with cancer is one of the most important challenges that oncologists face in daily practice, as the therapy selected depends on an assessment of the patient’s “fitness.”
Prevention of CNS seeding early in the metastatic disease course using drugs with both intra- and extracranial activity will be crucial to improving outcomes in patients with breast cancer brain metastases.
In this overview, we will review recent developments in the management of breast cancer brain metastases and current prospective trials of systemic therapies specifically for patients with breast cancer brain metastases, with a focus on novel pathway-specific therapies.