Brain metastasis treatment

Discuss the different treatment options for melanoma with brain metastasis. 

Brain metastasis is common in melanoma, and treatment options for brain metastasis include surgery, radiation, and chemotherapy. The choice of therapy depends on the number of metastatic lesions, accessibility of the lesions for surgery, the presence of neurologic symptoms, and the status of extracranial disease. 

Galicich JH, Sundaresan N, Thaler HT. Surgical treatment of single brain metastasis. Evaluation of results by computerized tomography scanning. J Neurosurg 1980 53 63—67. 

Fig. 5.12a, b. A 71-year-old male patient with bronchogenic carcinoma invading the mediastinum and brain metastasis. Superior vena cava obstruction syndrome was treated by placement of a Wallstent endoprosthesis in the superior vena cava. At 3 weeks after endoluminal treatment, obstruction symptoms recurred, a Phlebography obtained by a femoral approach and catheterization of the stent lumen showed stent obstruction, and extensive filling of mediastinal veins, b After balloon dilatation at the junction of the stent with the internal jugular vein, a residual stenosis (arrow), due to insufficient stent covering of mediastinal tumor extent was evident... 

Radiation is not standard therapy for the treatment of skin cancer however, there are circumstances in which radiation may be preferred. It is used as adjunctive therapy after surgical resection for patients with head and neck MM with metastasis to regional lymph nodes.40 Radiation is also indicated for patients with unresectable metastases or brain metastases or for palliation of symptoms from metastases.40 Older patients or patients who are poor candidates for surgery may be offered radiation as an option.40 Radiation offers good cosmetic results,... 

Because of early dissemination, staging of patients with small-cell lung cancer is more extensive than for patients with NSCLC. It is important to rule out distant metastasis because it will change the role of thoracic radiation in the treatment of these patients. Staging should include a complete history and physical examination, CAT scans of chest and upper abdomen to include the liver and adrenal glands, brain MRI scan, bone scan, complete blood count, and a possible bone marrow aspiration and biopsy. 

HVJ liposomes have been effective for the treatment of cancers. Glioblastoma is a severe type of brain tumor associated with rapid and extensive metastasis, and a gene therapy for disseminated glioblastoma is desirable. All mice injected with glioblastoma died, and the survival time was dependent on the number of cancer cells injected. After dissemination of mouse glioblastoma cells into mouse... 

Fortin D, Gendron C, Boudrias M, Garant MP. Enhanced chemotherapy delivery by intraarterial infusion and blood-brain barrier disruption in the treatment of cerebral metastasis. Cancer 2007 109 751-760. 

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