%0 Journal Article
%T Integration of chemotherapy into current treatment strategies for brain metastases from solid tumors
%A Carsten Nieder
%A Anca L Grosu
%A Sabrina Astner
%A Reinhard Thamm
%A Michael Molls
%J Radiation Oncology
%D 2006
%I BioMed Central
%R 10.1186/1748-717x-1-19
%X Local control of a limited number (mostly 1¨C3, in some series >3) of brain metastases can effectively be achieved by surgical resection or stereotactic radiosurgery (SRS) with or without adjuvant whole-brain radiotheray (WBRT) [1-9] (Table 1). The number of patients dying from uncontrolled brain metastases despite such intensive local treatment is comparably low and ranges from 20¨C30%. However, patients with brain metastases are a heterogeneous group where selection of the most appropriate treatment depends on many patient- and disease-related factors. Figure 1 provides an overview of potential factors influencing decision making. Eventually, a considerable proportion of patients with multiple brain metastases, which are not suitable for surgery or SRS, might be candidates for other palliative approaches such as WBRT alone or combined with chemotherapy. The latter combination has recently gained increasing attention and is hoped to augment the palliative effect of WBRT alone and to extend survival in certain subsets of patients. Certainly, maximing local control within the brain is most important in case of controlled extracranial disease and good performance status. So far, data from controlled clinical trials of combined chemo- and radiotherapy are still limited. The choice of chemotherapy regimen is often complicated by previous systemic treatment and takes into account the activity of the drugs in extracranial metastatic disease and the issue of drug concentration within the central nervous system, although it has been realized that the blood-brain barrier (BBB) is partially disrupted in most macroscopic metastases. Thus, systemically administered agents can gain access to such tumor sites. Sometimes, the question arises whether patients with newly detected brain metastases and the indication for systemic treatment of extracranial disease can undergo standard systemic chemotherapy with the option of deferred rather than immediate radiotherapy to the brain. The l
%U http://www.ro-journal.com/content/1/1/19