Metastatic Brain Tumors: Surgery – Treatment

by Roy Strowd, MD

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    00:01 How do we treat brain metastasis? Well, they're common.

    00:04 There's been a lot of studies and understanding about how we should treat these patients.

    00:08 Brain metastasis are the most common central nervous system malignancy, with about over 160,000 new cases per year.

    00:15 And there are two treatments that I want you to think about.

    00:19 The first is surgery or a craniotomy.

    00:22 Going in and taking out a symptomatic lesion, making a diagnosis, and then sending the patient to subsequent treatment.

    00:30 The second is radiation therapy.

    00:32 And we'll learn about multiple different types of radiation, including stereotactic radiosurgery, which you can see here that really reduces the risk of subsequent brain metastasis.

    00:42 And we'll talk more about this in the next few slides.

    00:46 When do we think about surgery? Well, surgery is really optimal in three situations.

    00:51 If there is a solitary, a single, one single lesion, we can go after it with surgery and help that patient.

    00:58 Lesions that are superficial, tumors that are superficial, are easy to access.

    01:02 And then importantly, those that are symptomatic as a result of mass effect that need decompression, or management of new patient symptoms.

    01:11 There are times when we worry about surgery.

    01:14 Surgery for metastasis in the posterior fossa is really important, but those tumors are at higher risk for seeding the leptomeningeal space.

    01:23 Postoperative radiation therapy to the resection cavity even after surgery is common in patients.

    01:29 So surgery may be the start of treatment, but often is not the end.

    01:35 There are some reasons to do a craniotomy, a surgery, and some contraindications. Some reason to worry about that.

    01:40 Indications or reasons to do surgery, or if the patient doesn't have a cancer diagnosis, and that's the tissue that we need to establish the patient's diagnosis.

    01:49 For large or symptomatic tumors, and typically those are tumors that are larger than three centimeters are associated with midline shift or mass effect around the brain.

    01:59 And then recurrent brain metastases that have previously been treated with radiosurgery or stereotactic radiation, or radiation therapy, and are higher risk for subsequent radiation treatment.

    02:08 There are also some times where we wouldn't want to do surgery.

    02:11 Eloquent area the are areas of the brain.

    02:13 That just are not amenable to surgical resection.

    02:17 When a patient's health is declining, or when surgery would delay, urgent need for a good chemotherapy.

    About the Lecture

    The lecture Metastatic Brain Tumors: Surgery – Treatment by Roy Strowd, MD is from the course CNS Tumors.

    Included Quiz Questions

    1. No previously known cancer diagnosis
    2. 1–2 cm asymptomatic mass
    3. Recurrent metastasis without prior radiotherapy
    4. Brainstem mass
    5. Need for urgent chemotherapy to increase its effect

    Author of lecture Metastatic Brain Tumors: Surgery – Treatment

     Roy Strowd, MD

    Roy Strowd, MD

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