Neurocognitive and quality-of-life endpoints must be incorporated into future studies of patients with cerebral metastases
Cerebral metastases remain a common complication among patients with systemic cancer, the incidence proportion being 9.6% in a recent review of the Metropolitan Detroit Cancer Surveillance System. The tumor types most likely to metastasize to the brain are lung (19.9% of all lung cancers), melanoma (6.9%), renal (6.5%), breast (5.1%), and colorectal (1.9%).1 Most cerebral metastases originate from lung, breast and melanoma. As therapies for systemic cancer improve and patients survive longer, the risk of cerebral metastases might increase. For example, a higher incidence of cerebral metastases has been reported among HER2-positive breast cancer patients who respond to trastuzumab, an anti-HER2 antibody with poor CNS penetration. Median overall survival for cerebral metastases remains less than 1 year, with most patients succumbing to systemic rather than CNS disease. Recent developments have challenged and extended the traditional treatment of choice, namely whole-brain radiotherapy (WBRT). In particular, stereotactic radiosurgery (SRS) has emerged as a possible alternative to WBRT and surgery.
