A modern approach to the treatment of brain metastases (literature review)
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Keywords

neurosurgery
oncological diseases
metastasis
brain lesions

How to Cite

Rashidi, B., & Karlova, T. (2026). A modern approach to the treatment of brain metastases (literature review). Medicine Today and Tomorrow, 95(1). https://doi.org/10.35339/msz.2026.95.1.rka

Abstract

In press

Background. A distinctive feature of malignant tumors, regardless of their primary site, is their ability to metastasize. According to clinical studies, brain metastases are frequently diagnosed in cancer patients, which significantly complicates the course of the primary disease and determines its prognosis. Despite the emergence of new therapeutic strategies, improving diagnostic and treatment approaches remains critically important. This underscores the need to systematize current scientific data in order to identify effective solutions for the prognosis, diagnosis, treatment, and management of this condition.

Aim. To analyze existing studies on the efficacy of various treatment methods for brain metastases, emphasizing the advantages and disadvantages of each method, including those based on statistical data.

Materials and Methods. The study material consists of thematic scientific reviews on the treatment of brain metastases. A literature search was conducted in Google Scholar and PubMed for the years 2010–2025 using the keywords brain tumors, treatment of metastases, and oncological diseases. A total of 47 sources were selected. The bibliosemantic method and the method of systematic analysis were used. The study was conducted as a private initiative of the authors without grant support or official registration of the topic.

Research Ethics. This study is based on publications conducted in accordance with current standards of bioethics.

Results. This paper outlines the challenges involved in identifying optimal methods for treating brain metastases, both through medical and surgical approaches, in combination with radiation therapy. It examines the therapeutic effects on symptoms, the significance of surgical treatment methods, the role of postoperative radiation therapy and stereotactic treatment methods in combination with radiation therapy, as well as the side effects of radiation therapy.

Conclusions. Despite the achievements of modern medicine, a large number of questions remain, the main ones being patient selection criteria and the optimal treatment sequence for maximum therapeutic benefit. The problem of metastatic brain lesions combines diagnostic challenges, the limitations of existing therapeutic approaches, and the need to improve treatment methods. This necessitates further research aimed at improving diagnostic capabilities, developing new therapeutic strategies, and increasing survival rates for patients with this condition.

Keywords: neurosurgery, oncological diseases, metastasis, brain lesions.

https://doi.org/10.35339/msz.2026.95.1.rka
PDF (Українська)

References

Achrol AS, Rennert RC, Anders C, Soffietti R, Ahluwalia MS, Nayak L, et al. Brain metastases. Nat Rev Dis Primers. 2019;5(1):5. DOI: 10.1038/s41572-018-0055-y. PMID: 30655533.

Liu Q, Tong X, Wang J. Management of brain metastases: history and the present. Chinese neurosurgical journal. 2019;5:1. DOI: 10.1186/s41016-018-0149-0. PMID: 32922901.

Suh JH, Kotecha R, Chao ST, Ahluwalia MS, Sahgal A, Chang EL. Current approaches to the management of brain metastases. Nat Rev Clin Oncol. 2020;17(5):279-99. DOI: 10.1038/s41571-019-0320-3. PMID: 32080373.

Vogelbaum MA, Brown PD, Messersmith H, Brastianos PK, Burri S, Cahill D, et al. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. Neuro-Oncology. 2022;24(3):331-57. DOI: 10.1093/neuonc/noab262

Eichler AF, Chung E, Kodack DP, Loeffler JS, Fukumura D, Jain RK. The biology of brain metastases-translation to new therapies. Nat Rev Clin Oncol. 2011;8(6):344-56. DOI: 10.1038/nrclinonc.2011.58. PMID: 21487419.

Cagney DN, Martin AM, Catalano PJ, Redig AJ, Lin NU, Lee EQ, et al. Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol. 2017;19(11):1511-21. DOI: 10.1093/neuonc/nox077. PMID: 28444227.

Davis FG, Dolecek TA, McCarthy BJ, Villano JL. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol. 2012;14(9):1171-7. DOI: 10.1093/neuonc/nos152. PMID: 22898372.

Dubenko OE, Kulinich H, Prokhorova EB, Kulchaeva TV, Danyliuk S. Brain metastases of cancer of unknown primary: presentation of clinical cases. Ukrainian Journal of Radiology and Oncology. 2023;31:124-37. DOI: 10.46879/ukroj.1.2023.124-137.

Gomez D, Feng JJ, Cheok S, Shah I, Dicharry H, Cote DJ, et al. Incidence of brain metastasis according to patient race and primary cancer origin: a systematic review. J Neurooncol. 2024;169(3):457-67. DOI: 10.1007/s11060-024-04748-6. PMID: 38896356.

Khanal K, Rajbhandari B, Pandey A, Sherpa PL, Parajuli S, Pandey N, et al. Malignant metastatic melanoma in brain with unknown primary origin: a case report. Ann Med Surg (Lond). 2024;10;86(11):6772-9. DOI: 10.1097/MS9.0000000000002562. PMID: 39525757.

Gryazov AB, Medvedovska YuV, Gryazov AA. Differential diagnostics of a radionecrosis and local tumoral recurrence according to arterial spin labeling after radiosurgery treatment of malignant gliomas of a brain. Wiad Lek. 2020;73(10):2160-4. PMID: 33310940.

Gryazov A.A., Lysianyi M.I., Gryazov A.B., Medvedovska Y.V. Assessment of the state of immune system in patients with metastatic and glial brain tumors at the preparatory stage of radiotherapy. Wiad Lek. 2022;75(7):1747-51. DOI: 10.36740/WLek202207125. PMID: 35962692

Bailleux C, Eberst L, Bachelot T. Treatment strategies for breast cancer brain metastases. Br J Cancer. 2021;124(1):142-55. DOI: 10.1038/s41416-020-01175-y. PMID: 33250512.

Lockman PR, Mittapalli RK, Taskar KS, Rudraraju V, Gril B, Bohn KA, et al. Heterogeneous blood-tumor barrier permeability determines drug efficacy in experimental brain metastases of breast cancer. Clin Cancer Res. 2010;16(23):5664-78. DOI: 10.1158/1078-0432.CCR-10-1564. PMID: 20829328.

Arvanitis CD, Ferraro GB, Jain RK. The blood-brain barrier and blood-tumour barrier in brain tumours and metastases. Nat Rev Cancer. 2020;20(1):26-41. DOI: 10.1038/s41568-019-0205-x. PMID: 31601988.

Lewis Phillips GD, Nishimura MC, Lacap JA, Kharbanda S, Mai E, Tien J, et al. Trastuzumab uptake and its relation to efficacy in an animal model of HER2-positive breast cancer brain metastasis. Breast Cancer Res Treat. 2017;164(3):581-91. DOI: 10.1007/s10549-017-4279-4. PMID: 28493046.

Nahed BV, Alvarez-Breckenridge C, Brastianos PK, Shih H, Sloan A, Ammirati M, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults with Metastatic Brain Tumors. Neurosurgery. 2019;84(3):E152-5. DOI: 10.1093/neuros/nyy542. PMID: 30629227.

Moravan MJ, Fecci PE, Anders CK, Clarke JM, Salama AKS, Adamson JD, et al. Current multidisciplinary management of brain metastases. Cancer. 2020;126(7):1390-406. DOI: 10.1002/cncr.32714.

Sperduto PW, Jiang W, Brown PD, Braunstein S, Sneed P, Wattson DA, et al. Estimating Survival in Melanoma Patients with Brain Metastases: An Update of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA). Int J Radiat Oncol Biol Phys. 2017;99(4):812-6. DOI: 10.1016/j.ijrobp.2017.06.2454. PMID: 29063850.

Sperduto PW, Yang TJ, Beal K, Pan H, Brown PD, Bangdiwala A, et al. Estimating Survival in Patients with Lung Cancer and Brain Metastases: An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA). JAMA Oncol. 2017;3(6):827-31. DOI: 10.1001/jamaoncol.2016.3834. PMID: 27892978.

Arbour KC, Mezquita L, Long N, Rizvi H, Auclin E, Ni A, et al. Impact of Baseline Steroids on Efficacy of Programmed Cell Death-1 and Programmed Death-Ligand 1 Blockade in Patients with Non-Small-Cell Lung Cancer. J Clin Oncol. 2018;36(28):2872-8. DOI: 10.1200/JCO.2018.79.0006. PMID: 30125216.

Ricciuti B, Dahlberg SE, Adeni A, Sholl LM, Nishino M, Awad MM. Immune Checkpoint Inhibitor Outcomes for Patients with Non-Small-Cell Lung Cancer Receiving Baseline Corticosteroids for Palliative Versus Nonpalliative Indications. J Clin Oncol. 2019;37(22):1927-34. DOI: 10.1200/JCO.19.00189. PMID: 31206316.

Scott SC, Pennell NA. Early Use of Systemic Corticosteroids in Patients with Advanced NSCLC Treated with Nivolumab. J Thorac Oncol. 2018;13(11):1771-5. DOI: 10.1016/j.jtho.2018.06.004. PMID: 29935305.

Prasad V, Elhag A, Onyiriuka L, Mthunzi E, Hatch S, Naeem A, et al. Dexamethasone in brain tumor patients: a real-world pharmacovigilance audit. Front Neurol. 2025;16:1632231. DOI: 10.3389/fneur.2025.1632231. PMID: 40909003.

Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG. Antiepileptic drugs as prophylaxis for postcraniotomy seizures. Cochrane Database Syst Rev. 2018;5(5):CD007286. DOI: 10.1002/14651858.CD007286.pub4. PMID: 29791030.

Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1040-8. DOI: 10.1016/S1470-2045(17)30414-X. Erratum in: Lancet Oncol. 2017;18(8):e433. DOI: 10.1016/S1470-2045(17)30530-2. Erratum in: Lancet Oncol. 2017;18(9):e510. DOI: 10.1016/S1470-2045(17)30636-8. PMID: 28687375.

Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049-60. DOI: 10.1016/S1470-2045(17)30441-2. PMID: 28687377.

Gui C, Moore J, Grimm J, Kleinberg L, McNutt T, Shen C, et al. Local recurrence patterns after postoperative stereotactic radiation surgery to resected brain metastases: A quantitative analysis to guide target delineation. Pract Radiat Oncol. 2018;8(6):388-96. DOI: 10.1016/j.prro.2018.04.010. PMID: 30029965.

Prabhu RS, Miller KR, Asher AL, Heinzerling JH, Moeller BJ, Lankford SP, et al. Preoperative stereotactic radiosurgery before planned resection of brain metastases: updated analysis of efficacy and toxicity of a novel treatment paradigm. J Neurosurg. 2018;131(5):1387-94. DOI: 10.3171/2018.7.JNS181293. PMID: 30554174.

Barbour AB, Jacobs CD, Williamson H, Floyd SR, Suneja G, Torok JA, Kirkpatrick JP. Radiation Therapy Practice Patterns for Brain Metastases in the United States in the Stereotactic Radiosurgery Era. Adv Radiat Oncol. 2019;5(1):43-52. DOI: 10.1016/j.adro.2019.07.012. PMID: 32051889.

Trifiletti DM, Ballman KV, Brown PD, Anderson SK, Carrero XW, Cerhan JH, et al. Optimizing Whole Brain Radiation Therapy Dose and Fractionation: Results from a Prospective Phase 3 Trial (NCCTG N107C [Alliance]/CEC.3). Int J Radiat Oncol Biol Phys. 2020;106(2):255-60. DOI: 10.1016/j.ijrobp.2019.10.024. PMID: 31654784.

Verduin M, Zindler JD, Martinussen HM, Jansen RL, Croes S, Hendriks LE, et al. Use of Systemic Therapy Concurrent with Cranial Radiotherapy for Cerebral Metastases of Solid Tumors. Oncologist. 2017;22(2):222-35. DOI: 10.1634/theoncologist.2016-0117. PMID: 28167569.

Chen L, Douglass J, Kleinberg L, Ye X, Marciscano AE, Forde PM, et al. Concurrent Immune Checkpoint Inhibitors and Stereotactic Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer, Melanoma, and Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys. 2018;100(4):916-25. DOI: 10.1016/j.ijrobp.2017.11.041. PMID: 29485071.

Lehrer EJ, Peterson J, Brown PD, Sheehan JP, Quiñones-Hinojosa A, Zaorsky NG, Trifiletti DM. Treatment of brain metastases with stereotactic radiosurgery and immune checkpoint inhibitors: An international meta-analysis of individual patient data. Radiother Oncol. 2019;130:104-12. DOI: 10.1016/j.radonc.2018.08.025. PMID: 30241791.

Schapira E, Hubbeling H, Yeap BY, Mehan WA Jr, Shaw AT, Oh K, et al. Improved Overall Survival and Locoregional Disease Control with Concurrent PD-1 Pathway Inhibitors and Stereotactic Radiosurgery for Lung Cancer Patients with Brain Metastases. Int J Radiat Oncol Biol Phys. 2018;101(3):624-9. DOI: 10.1016/j.ijrobp.2018.02.175. PMID: 29678530.

Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, et al. Effect of Radiosurgery Alone vs Radiosurgery with Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial. JAMA. 2016;316(4):401-9. DOI: 10.1001/jama.2016.9839. PMID: 27458945.

Antoni D, Mesny E, El Kabbaj O, Josset S, Quintin K, Boue-Rafle A, et. Radiotherapy for brain metastases: 2025 update. Cancer Radiother. 2025;29(7-8):104765. DOI: 10.1016/j.canrad.2025.104765. PMID: 41205451.

Mulvenna P, Nankivell M, Barton R, Faivre-Finn C, Wilson P, McColl E, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet. 2016;388(10055):2004-14. DOI: 10.1016/S0140-6736(16)30825-X. PMID: 27604504.

Paz-Ares L, Luft A, Vicente D, Tafreshi A, Gümüş M, Mazières J, et al. Pembrolizumab plus Chemotherapy for Squamous Non-Small-Cell Lung Cancer. N Engl J Med. 2018;379(21):2040-51. DOI: 10.1056/NEJMoa1810865. PMID: 30280635.

Natarajan BD, Rushing CN, Cummings MA, Jutzy JM, Choudhury KR, Moravan MJ, et al. Predicting intracranial progression following stereotactic radiosurgery for brain metastases: Implications for post SRS imaging. J Radiosurg SBRT. 2019;6(3):179-87. PMID: 31998538.

Ocaña-Tienda B, Pérez-Beteta J, Romero-Rosales JA, Asenjo B, Ortiz de Mendivil A, Pérez Romasanta LA, et al. Volumetric analysis: Rethinking brain metastases response assessment. Neurooncol Adv. 2023;6(1):vdad161. DOI: 10.1093/noajnl/vdad161. PMID: 38187872.

Alemany M, Velasco R, Simó M, Bruna J. Late effects of cancer treatment: consequences for long-term brain cancer survivors. Neurooncol Pract. 2020;8(1):18-30. DOI: 10.1093/nop/npaa039. PMID: 33664966.

Vellayappan B, Tan CL, Yong C, Khor LK, Koh WY, Yeo TT, Detsky J, Lo S, Sahgal A. Diagnosis and Management of Radiation Necrosis in Patients With Brain Metastases. Front Oncol. 2018;8:395. DOI: 10.3389/fonc.2018.00395. PMID: 30324090.

Narloch JL, Farber SH, Sammons S, McSherry F, Herndon JE, Hoang JK, et al. Biopsy of enlarging lesions after stereotactic radiosurgery for brain metastases frequently reveals radiation necrosis. Neuro Oncol. 2017;19(10):1391-7. DOI: 10.1093/neuonc/nox090. PMID: 28472527.

Jones KM, Michel KA, Bankson JA, Fuller CD, Klopp AH, Venkatesan AM. Emerging Magnetic Resonance Imaging Technologies for Radiation Therapy Planning and Response Assessment. Int J Radiat Oncol Biol Phys. 2018;101(5):1046-56. DOI: 10.1016/j.ijrobp.2018.03.028. PMID: 30012524.

Patel JS, Salari E, Chen X, Switchenko J, Eaton BR, Zhong J, et al. Radiomic Analysis of Treatment Effect for Patients with Radiation Necrosis Treated with Pentoxifylline and Vitamin E. Tomography. 2024;10(9):1501-12. DOI: 10.3390/tomography10090110. PMID: 39330756.

Kotecha R, Gondi V, Ahluwalia MS, Brastianos PK, Mehta MP. Recent advances in managing brain metastasis. F1000Res. 2018;7:F1000_Faculty_Rev-1772. DOI: 10.12688/f1000research.15903.1. PMID: 30473769.

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