Chemotherapy in brain metastases.

Abstract:

:The use OF chemotherapy to treat patients with brain metastases has been viewed historically with skepticism. To date, a survival benefit has not been demonstrated with the use of systemic chemotherapy in patients with brain metastases. However, the introduction of novel agents and delivery techniques warrants a reexamination of the role of systemic chemotherapy in the management of brain metastases. Temozolomide has shown encouraging results in patients with nonsmall cell lung cancer, and implanted carmustine wafers have demonstrated excellent local tumor control rates. This review discusses clinical data from the past decade with emphasis on trial design, tumor histology, available agents, and multimodality strategies. In addition, delivery techniques that circumvent the blood-brain barrier are reviewed. Although chemotherapy is usually used as a salvage therapy, it may be considered for use in selected patients with newly diagnosed brain metastases. To better evaluate chemotherapy in brain metastases, future trials should evaluate novel agents in the preirradiation setting. Enhanced regional delivery methods warrant further investigation, and Phase III trials of current regimens stratified by histology and by prognostic factors will establish the role of specific chemotherapy regimens in the treatment of patients with brain metastases.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Peereboom DM

doi

10.1227/01.neu.0000182740.39014.9a

subject

Has Abstract

pub_date

2005-11-01 00:00:00

pages

S54-65; discusssion S1-4

issue

5 Suppl

eissn

0148-396X

issn

1524-4040

pii

00006123-200511001-00013

journal_volume

57

pub_type

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