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Considerations in the Diagnosis and Management of Brain Metastases

Considerations in the Diagnosis and Management of Brain Metastases

Dr. Sawaya provides a comprehensive review and citation of
the key references that have shaped the current management of cerebral
metastases. The reader is directed to the importance of this aspect of cancer
management by carefully documented sections that center on the epidemiology of
these lesions.

In ruminating on the information in Dr. Sawaya’s review and the comments
that follow, it must be recognized that the management of cerebral metastases
varies, depending on the timing of the needed intervention, and certain
variables obviate the ability to make algorithms that are as neat as one might
initially wish. Newly diagnosed lesions are approached differently than
recurrent or progressive disease, depending on prior treatment and the current
systemic health of the patient.

Threshold for Investigation
of Symptoms

As in all aspects of cancer management, early detection of a tumor or its
subsequent progression is key to effective intervention. Although there is a
sense that central nervous system (CNS) involvement is such an adverse
development prognostically that some clinicians may not pursue evaluation of
neurologic symptoms, the data provided in this review suggest that a number of
treatment options are available.

Therefore, individuals with established cancers, particularly cancers prone
to involve the CNS (such as lung and breast cancer and melanoma), warrant
careful observation for the onset of neurologic symptoms or focal neurologic
deficits. In patients with previously confirmed CNS involvement, regular
clinical and imaging follow-up is critical to early detection of progression.

MRI in Screening, Diagnosing,
and Managing CNS Metastases

Magnetic resonance imaging (MRI) scans of the brain and spine have proven to
be the most effective means of screening individuals with headaches, seizures,
or new focal cranial nerve, motor, sensory, or coordination deficits suspected
to be caused by a tumor. The use of a contrast agent is key to this type of
study. For intraparenchymal lesions, MRI frequently provides all the information
necessary to make treatment decisions.


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