Brain metastases from solid tumors: disease outcome according to type of treatment and therapeutic resources of the treating center

Four Cancer centres participated to the survey. Data were collected through a questionnaire filled in by one physician for each centre.Clinical data regarding 290 cancer patients with BMs from solid tumors were collected. Median age was 59 and 59% of patients had ≤ 3 brain metastases. A local approach (surgery and stereotactic radiosurgery) was adopted in 31% of patients. The local approach demonstrated to be superior in terms of survival compared to the regional/systemic approach (whole brain radiotherapy and chemotherapy, p = <.0001 for survival at 2 years). In the multivariate analysis local treatment was an independent prognostic factor for survival. When patients were divided into 2 groups whether they were treated in centers where local approaches were available or not (group A vs group B respectively, 58% of patients with ≤ 3 BMs in both cohorts), more patients in group A received local strategies although no difference in time to brain progression at 1 year was observed between the two groups of patients.In clinical practice, local strategies should be integrated in the management of brain metastases. Proper selection of patients who are candidate to local treatments is of crucial importance.Intracranial metastases represent the most common brain tumors, occurring in 25-50% of all cancer patients (based on clinical studies, hospital records and autopsy series) [1,2]. Given the high rate of cancer patients who will metastasize to the brain during the course of their disease, brain metastases (BMs) constitute a major health care problem. As new and more effective therapies for treating primary tumors lengthen patient survival and the availability of enhanced cerebral imaging techniques favors the detection of small and asymptomatic brain lesions, the incidence of BMs is expected to increase.In adults, lung cancer is the main cause of BMs (50-60%), followed by breast cancer (15-20%) and melanoma (5-10%) respectively, while tumors of the gastrointestinal tract a