With the advancement of cancer treatment technology, the prolongation of the survival of cancer patients, and the advancement of various tests, the detection rate of brain metastases has continued to increase.
Brain metastases are a class of extremely harmful malignant tumors that often cause neurological dysfunction, including headaches, seizures, hemiplegia, hemiplegia, hemiparesis, and cognitive impairment, which seriously affect the quality of life and survival of patients. If left untreated, patients survive only about one month [1].
Therefore, it is urgent to actively standardize the treatment of brain metastases, prolong the survival of patients, and improve the quality of life.
Which tumors are more susceptible to brain metastasis?
The incidence of brain metastases has been reported to be 3.5% to 10.0% of intracranial tumors, mainly from lung cancer (29% to 56%), breast cancer (5% to 20%), and melanoma (7% to 16%).
Although the incidence of brain metastases in sarcomas, malignant blacks, and chorionic carcinoma can reach 50% to 90%, due to their low incidence, brain metastases are not clinically common.
What are the symptoms of brain metastases?
Increased intracranial pressure
The main manifestations are headache, vomiting, and optic nerve papilledema. In addition to these three main signs, diplopia, blackness, vision loss, dizziness, apathy, impaired consciousness, binubic incontinence, slow pulse, and increased blood pressure can also occur.
Movement disorders
Presents with decreased muscle strength in the limb on the contralateral side of the tumor or complete paralysis of upper motor neurons.
Visual field damage
Occipital and parietal lobes, deep temporal lobe tumors due to involvement of visual radiation, resulting in contralateral visual field defects or contralateral hemianopia.
Psychiatric symptoms
Commonly found in frontal lobe tumors, it can manifest as altered temperament, unresponsiveness, and dementia.
Seizures
Frontal lobe tumors are more common, followed by temporal lobe and parietal lobe tumors.
Cranial nerve involvement
Common cranial nerves involved include optic nerve, oculomotor nerve, sledge nerve, abducens nerve, facial nerve, auditory nerve, etc., which are manifested by decreased vision, diplopia, facial numbness, taste and hearing abnormalities, swallowing and dysphonia.
What tests do I need to do if brain metastases are suspected?
Many tumor patients often confuse with radiotherapy and chemotherapy or some drug side effects when they have the above symptoms of nausea, vomiting, dizziness, etc., thereby delaying the early treatment of brain metastases.
Therefore, we recommend that tumor patients should undergo a skull enhancement nuclear magnetic (MRI) examination regularly (every 3-6 months), which can clearly show the location, size, number of lesions of the metastases, and concurrent intracranial lesions such as cerebral edema and hydrocephalus, and can detect brain metastases early.
CT, PET, SPECT, etc. can also be used as auxiliary examination methods to improve the diagnosis rate of brain metastases.
How is brain metastases treated?
Radiotherapy
Whole-brain radiotherapy is a treatment for classic brain metastases that can be used alone or as a supplement to stereotactic radiation (including stereotactic radiotherapy, gamma knife) or surgery. The literature reports that the total effective rate of radiation therapy for brain metastases is about 60% to 80%.
drug therapy
Dehydration and diuretic therapy are given aggressively to lower cranial pressure, with options including mannitol, glyceryl fructose, and furosemide.
Glucocorticoids. In particular, dexamethasone reduces cerebral edema and improves the quality of life in patients with brain metastases, but does not improve prognosis.
Control symptoms. Including antiepileptic and analgesic therapy, antiepileptic drugs do not reduce the number of seizures in patients with brain metastases, so they are generally used only in patients with seizure symptoms and are not used prophylactically [2]. Patients with severe headaches may be treated with painkillers.
Targeted drugs. Such as aletinib, lauratinib.
Surgical treatment
01
Single-onset brain metastases
Patients with single,resectable, systemic well-conditioned, no extracranial lesions or well-controlled brain metastases, particularly single-episode brain metastases with significant mass effects that cause increased intracranial pressure or obstructive hydrocephalus, may benefit from surgery.
02
Multiple brain metastases
It is generally believed that multiple brain metastases have a poor prognosis because of their short survival and do not advocate surgery.
Write at the end
Brain metastasis is closely related to pathological staging, treatment methods, personal constitution, treatment compliance, living habits, etc.! Currently, there is no clear and effective method that can prevent it, but the risk of brain metastases can be reduced by:
Regular review, early detection and early treatment;
Sleep enough, exercise properly, quit smoking and alcohol, eat a balanced and nutritious diet;
Keep a good attitude.
bibliography
1、JenkinsonMD，HaylockB，ShenoyA，etal．Managementofcerebralmetastasis:Evidence-basedapproachforsurgery，stereotacticradiosurgeryandradiotherapy［J］．EuropeanJournalofCancer，2011，47(5)∶649-655．
2、MikkelsenT,PaleologosNA,RobinsonPD,etal. Theroleofprophylacticanticonvulsantsinthemanagementofbrainmetastases:asystematicreviewandevidence．