Abstract
Brain metastases (BM) are the most common metastatic complication of systemic cancer to the central nervous system (CNS). Treatment is most often with radiotherapy (whole brain radiotherapy (WBRT), stereotactic radiotherapy (SRT) or a combination) and in selected patients (for example solitary metastasis) resective surgery. The role for chemotherapy in the treatment of BM is difficult to define due to a paucity of clinical trials the majority of which are nonrandomized, retrospective studies and case reports. Two factors influence the efficacy of chemotherapy in BM; the intrinsic chemosensitivity of the tumor and chemotherapy drug delivery. Several generalizations can be made regarding chemotherapy of BM based on the limited literature. Response to chemotherapy reflects inherent chemosensitivity of the primary tumor with best responses seen with small cell lung cancer, intermediate responses seen with non-small cell lung cancer and breast cancer and low response rates with melanoma. Response to chemotherapy is in addition determined by prior chemotherapy exposure as front-line chemotherapy has higher response rates than second- or third-line chemotherapy. Response to chemotherapy as compared to WBRT or SRT is inferior and less durable. The use of chemotherapy for the treatment of BM is most often limited to patients having failed radiotherapy (often both WBRT and SRT) and with multiple lesions. Emerging data suggests that targeted therapies may play an increasing role in the treatment of BM.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Talmadge JE, Fidler IJ (2010) AACR centennial series: the biology of cancer metastasis: historical perspective. Cancer Res 70:5649–5669
Fidler IJ (2003) The pathogenesis of cancer metastasis: the seed and soil hypothesis revisited. Nat Rev Cancer 3:453–458
Khuntia D, Brown P, Li J, Mehta M (2006) Whole brain radiotherapy in the management of brain metastasis. J Clin Oncol 24:1295–1304
Langer CJ, Mehta M (2005) Current management of brain metastases, with a focus on systemic options. J Clin Oncol 23:6207–6219
Norden AD, Wen PY, Kesari S (2005) Brain metastases. Curr Opin Neurol 18:279–292
Posner JB, Chernik NL (1978) Intracranial metastases from systemic cancer. Adv Neurol 19:579–592
Zimm S, Wampler GL, Stablein D et al (1981) Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer 48:384–394
Posner JB (1996) Brain metastases: 1995. A brief review. J Neurooncol 27:287–293
Chang JE, Robins HI, Mehta MP (2007) Therapeutic advances in the treatment of brain metastases. Clin Adv Hematol Oncol 5:54–64
Barnholtz-Sloan J, Sloan A, Davis F et al (2004) Incidence proportions of brain metastases in patients diagnosed (1973–2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 22:2865–2872
Suh JH, Chao ST, Vogelbaum MA (2009) Management of brain metastases. Curr Neurol Neurosci Rep 9:223–230
Gaspar LE, Chansky K, Albain KS et al (2005) Time from treatment to subsequent diagnosis of brain metastases in stage III non–small-cell lung cancer: a retrospective review by the Southwest Oncology Group. J Clin Oncol 25:2955–2961
Pottgen C, Eberhardt W, Grannass A et al (2007) Prophylactic cranial irradiation in operable stage IIIa non-small cell lung cancer treated with neoadjuvant chemoradiotherapy: results from a German Multicenter randomized trial. J Clin Oncol 31:4987–4992
Auperin A, Arriagada R, Pignon JP et al (1999) Prophylactic cranial irradiation for patients with small cell lung cancer in complete remission. N Engl J Med 341:476–484
Slotman B, Faivre-Finn C, Kramer G et al (2007) Prophylactic cranial irradiation in extensive small cell lung cancer. N Engl J Med 557:664–672
Gregor A, Cull A, Stephens RJ et al (1997) Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: results of a Multicenter randomized trial: United Kingdom Coordinating Committee for Cancer Research (UKCCCR) and the European Organization for Research and Treatment of Cancer (EORTC). Eur J Cancer 33:1752–1758
Lin N, Bellon JR, Winer EP (2004) CNS metastases in breast cancer. J Clin Oncol 22:3608–3617
Lin NU, Carey LA, Liu M et al (2004) Phase II trial of lapatinib for brain metastases in patients with epidermal growth factor receptor-2 positive breast cancer. J Clin Oncol 12:1993–1999
Burnstein HJ, Lieberman SDJ, Winer EP, Klein P (2005) Isolated central nervous system metastases in patients with HER2-overexpressing advanced breast cancer treated with first line trastuzumab-based therapy. Ann Oncol 16:1772–1777
Miller K et al (2003) Occult central nervous system metastasis from breast cancer: prevalence, predictive factors ands impact on overall survival. Ann Oncol 14:1072–1077
Muller A, Homey B, Soto H et al (2001) Involvement of chemokine receptors in breast cancer metastasis. Nature 410:50–56
Hassan S, Ferrario C, Saragovi U et al (2009) The influence of tumor-host interactions in the stromal cell-derived factor-1/CXCR4 ligand/receptor axis in determining metastatic risk in breast cancer. Am J Pathol 175:66–73
Cabioglu N, Summy J, Miller C et al (2005) CXCL-12/stomal cell-derived factor-1 alpha transactivates HER2-neu in breast cancer cells by a novel pathway involving Src kinase activation. Cancer Res 65:6493–6497
Li YM, Pan Y, Wei Y et al (2004) Upregulation of CXCR4 is essential for HER2-mediated tumor metastasis. Cancer Cell 6:429–430
Raizer JJ, Hwu WJ, Panageas KS et al (2008) Brain and leptomeningeal metastases from cutaneous melanoma: survival outcomes based on clinical features. J Neurooncol 2:199–207
Tosoni A, Lumachi F, Brandes AA (2004) Treatment of brain metastases inuncommon tumors. Expert Rev Anticancer Ther 4:783–793
Gabos Z, Sinha R, Hanson J et al (2006) Prognostic significance of human epidermal growth factor receptor positivity for the development of brain metastasis after newly diagnosed breast cancer. J Clin Oncol 24:5658–5663
Lesser GT (1996) Chemotherapy of cerebral metastases from solid tumors. Neurosurg Clin N Am 7:527–536
Peerboom DM (2005) Chemotherapy in brain metastases. Neurosurgery 57(5 Suppl):S54–S65
Buckner JC (1991) The role of chemotherapy in the treatment of patients with brainmetastases from solid tumors. Cancer Metastasis Rev 10:335–341
Vecht CJ, Hovestadt A, Verbiest HBC, van Vliet JJ, van Putten WLJ (1994) Dose effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8 and 16 mg per day. Neurology 44:675–680
Batchelor TT, Taylor LP, Thaler HT, Posner JB, DeAngelis LM (1997) Steroid myopathy in cancer patients. Neurology 48:1234–1238
Glantz MJ, Cole BF, Forsyth PA et al (1997) Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the quality standards subcommittee of the American Academy of Neurology. Neurology 54:1886–1893
Hwu W, Lis E, Menell JH et al (2005) Temozolomide plus thalidomide in patients with brain metastases from Melanoma. Cancer 103:2590–2597
Mehta MP, Rodrigus P, Terhaard CH et al (2003) Survival and neurological outcomes in a randomized trial of motexafin gadolinium and whole brain radiation therapy in brain metastases. J Clin Oncol 21:2529–2536
Shaw E, Scott C, Suh J et al (2003) RSR13 Plus cranial radiation therapy in patients with brain metastases: comparison with Radiation Therapy Oncology Group Recursive Partitioning Analysis brain metastases database. J Clin Oncol 21:2364–2371
Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751
Sperduto CM, Watanabe Y, Mullan J et al (2008) A validation study of a new prognostic index for patients with brain metastases: the graded prognostic assessment. J Neurosurg 109(Suppl):87–89
Soffetti R, Mueller RP, Abacioglu MU et al (2009) Adjuvant whole brain radiotherapy versus observation after radiosurgery or surgical resection of 1–3 cerebral metastases--results of the EORTC 22952–26001 study. Neuro Oncol 11:662, Abstract #433
Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI (1999) Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys 43:795–803
Andrews DW, Scott CB, Sperduto PW et al (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomized trial. Lancet 363:1665–1672
Greig NH (1984) Chemotherapy of brain metastases: current status. Cancer Treat Rev 11:157–186
Kortmann RD, Jeremic B, Weller M, Plasswilm L, Bamberg M (2003) Radiochemotherapy of malignant glioma in adults: clinical experiences. Strahlenther Onkol 179:219–232
Deeken J, Löscher W (2007) The blood–brain barrier and cancer: transporters, treatment, and Trojan horses. Clin Cancer Res 13:1663–1674
Abrey LE, Olson JD, Raizer JJ et al (2001) A phase II trial of temozolomide for patients with recurrent or progressive brain metastases. J Neurooncol 53:259–265
Agarwala SS, Kirkwood JM, Gore M (2004) Temozolomide for the treatment of brain metastasis associated with metastatic melanoma. J Clin Oncol 22:2101–2107
Christodoulou C, Bafaloukos D, Kosmidis P et al (2001) Phase II study of temozolomide in heavily pretreated cancer patients with brain metastases. Ann Oncol 12:249–254
Dziadziuszko R, Ardizzoni A, Postmus PE et al (2003) Temozolomide in patients with advanced non-small cell lung cancer with and without brain metastases: a phase II study of the EORTC Lung Cancer Group (08965). Eur J Cancer 39:1271–1276
Friedman HS, Evans B, Reardon D et al (2003) Phase II trial of temozolomide for patients with progressive brain metastases. Proc Am Soc Clin Oncol 22:102, abstr
Giannitto-Giorgio C, Cordio S, Di Blasi C (2005) Temozolomide shows promising activity against pretreated brain recurrences of NSCLC. Preliminary results of a phase II trial (abstr). http://www.asco.org/ac/1,1003,_12-002643-00_18-0016-00_19-002779,00.asp. Accessed 20 Jan 2005
Siena S, Landonio G, Baietta E et al (2003) Multicenter phase II study of temozolomide therapy for brain metastasis in patients with malignant melanoma, breast cancer, and non-small cell lung cancer. Proc Am Soc Clin Oncol 22:102, abstr
Arena FP, Kurzyna-Solinas A, Treanor S et al (2003) Efficacy of temozolomide in heavily pretreated patients with stage IV breast cancer with or without brain metastasis. Proc Am Soc Clin Oncol 22:54, abstr 215
Schadendorf D, Hauschild A, Ugurel S et al (2006) Dose-intensified biweekly Temozolomide in patients with asymptomatic brain metastases from malignant melanoma: a phase 2 DeCOG/ADO study. Ann Oncol 17:1592–1597
Boogerd W, de Gast GC, Dalesio O (2007) Temozolomide in advanced malignant melanoma with small brain metastases: can we withhold cranial irradiation? Cancer 109:306–312
Lorusso V, Galetta D, Giotta F et al (2006) Topotecan in the treatment of brain metastases:a phase II study of GOIM (Gruppo Oncologico dell’Italia Meridionale). Anticancer Res 26:2259–2263
Oberoff C, Kieback DG, Wurstlein R et al (2001) Topotecan chemotherapy in patients with breast cancer and brain metastases: results of a pilot study. Onkologie 24:256–260
Manegold C, Pawel JV, Scheithauer W et al (1996) Response of SCLC brain metastases to toptotecan therapy. Ann Oncol 7(suppl 50):106–107
Ardizzoni A, Hansen H, Dombernowsky P et al (1997) Topotecan, a new active drug in the second-line treatment of small cell lung cancer: a phase II study in patients with refractory and sensitive disease. J Clin Oncol 15:2090–2096
Depierre A, von Pawel J, Hans K et al (1997) Evaluation of topotecan (Hycamtin) in relapsed small cell lung cancer (SCLC): a multicenter phase II study. Lung Cancer 18(suppl 1):35
Schutte W, Manegold C, von Pawel JV (1998) Topotecan in the therapy of brain metastases in lung cancer. Onkologie 21(suppl 4):25–27
Korfel A, Oehm C, von Pawel JV et al (2002) Response to topotecan of symptomatic brain metastases of small cell lung cancer after whole brain radiotherapy: a multicenter phase II study. Eur J Cancer 38:1724–1729
Zulkowski K, Kath R, Semrau R et al (2001) Regression of brain metastases from breast carcinoma after chemotherapy with bendamustine. J Cancer Res Clin Oncol 128:111–113
Wang MLH, Yung WAK, Royce ME et al (2001) Capecitabine for 5-fluorouracil resistant brain metastases from breast cancer. Am J Clin Oncol 24:421–424
Pons H, von Eyben FE, Sorensen OS et al (1991) Long-term remission of multiple brain metastases with tamoxifen. J Neurooncol 10:173–177
Stewart DJ, Dahrouge S (1995) Response of brain metastases from breast cancer to megestrol acetate: a case report. J Neurooncol 24:299–301
Boogerd W, Dalesio O, Bais EM, van der Sande JJ (1992) Response of brain metastases from breast cancer to systemic chemotherapy. Cancer 69:972–980
Ewend MG, Brem S, Gilbert M et al (2007) Treatment of single brain metastasis with resection, intracavity carmustine polymer wafers, and radiation therapy is safe and provides excellent local control. Clin Cancer Res 13:3637–3641
Golden GA, Meldorf M, PROLONG Study Group (2004) Patients with metastatic brain cancer, undergoing resection and Gliadel implantation experienced low local recurrence rates in the PROLONG Registry. Presented at the annual meeting of the Society of Neuro-Oncology Toronto, ON, Canada, 18–21 Nov 2004 (abstr)
Brem S, Sampath R, Staller A, Panattil, Entis S, Chamberlain M (2006) Local control of brain metastases after craniotomy, radiation therapy and implantable chemotherapeutic wafers. American Association of Neurological Surgeons. San Francisco, CA 22–26 Apr, 2006. J Neurosurg 104:A698 (abstr)
Cappuzzo F, Ardizzoni A, Soto-Parra H et al (2003) Epidermal growth factor receptor targeted therapy by ZD 1839 (Iressa) in patients with brain metastases from non-small-cell lung cancer (NSCLC). Lung Cancer 41:227–231
Ceresoli G, Cappuzzo F, Gregorc V et al (2004) Gefitinib in patients with brain metastases from non-small-cell lung cancer: a prospective trial. Ann Oncol 15:1042–1047
Hotta K, Kiura K, Ueoka H et al (2004) Effect of Gefitinib (‘Iressa’, ZD1839) on Brain Metastases in patients with advanced non-small cell lung cancer. Lung Cancer 46:255–261
Namba Y, Kijima T, Yokota S et al (2004) Gefitinib in patients with Brain Metastases from Non-Small-Cell Lung Cancer: review of 15 clinical cases. Clin Lung Cancer 6:123–128
Shimato S, Mitsudomi T, Kosaka T et al (2006) EGFR mutations in patients with brain metastases from lung cancer: association with the efficacy of gefitinib. J Neurooncol 8:137–144
Jacquillat C, Khayat D, Banzet P et al (1990) Final report of the French Multicenter Phase II study of the Nitrosourea Fotemustine in 153 evaluable patients with disseminated malignant melanoma including patients with cerebral metastases. Cancer 66:1873–1878
Bearz A, Garassino I, Tiseo M et al (2010) Activity of pemetrexed on brain metastases from Non-Small Cell Lung Cancer. Lung Cancer 68:264–268
Omlin A, D’Addario G, Gillessen S, Cerny T, von Hessling A, Früh M (2009) Activity of pemetrexed against brain metastases in a patient with adenocarcinoma of the lung. Lung Cancer 65:383–384
Barlesi F, Gervais R, Lena H et al (2011) Pemetrexed and cisplatin as first-line chemotherapy for advanced non-small-cell lung cancer (NSCLC) with asymptomatic inoperable brain metastases: a multicenter phase II trial (GFPC 07–01). Ann Oncol 22:2466–2470
Braganca KC, Janjigian YY, Azzoli CG et al (2010) Efficacy and safety of bevacizumab in active brain metastases from non-small cell lung cancer. J Neurooncol 100:443–447
Gow CH, Chien CR, Chang YL et al (2008) Radiotherapy in lung adenocarcinoma with brain metastases: effects of activating epidermal growth factor receptor mutations on clinical response. Clin Cancer Res 14:162–168
Eichler AF, Kahle KT, Wang DL et al (2010) EGFR mutation status and survival after diagnosis of brain metastasis in nonsmall cell lung cancer. J Neurooncol 12:1193–1199
Hodi FS, O’Day SJ, McDermott DF et al (2010) Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med 363:711–723
Flaherty KT, Puzanov I, Kim KB et al (2010) Inhibition of mutated, activated BRAF in metastatic melanoma. N Engl J Med 363:809–819
Margolin KA, Di Giacomo AM, Maio M (2010) Brain metastasis in melanoma: clinical activity of CTLA-4 antibody therapy. Semin Oncol 37:468–472
Ribas A, Flaherty KT (2011) BRAF targeted therapy changes the treatment paradigm in melanoma. Nat Rev Clin Oncol 8:426–433
Chapman PB, Hauschild A, Robert C et al (2011) BRIM-3 study group. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 364:2507–2516
Lin NU, Diéras V, Paul D et al (2009) Multicenter phase II study of lapatinib in patients with brain metastases from HER2-positive breast cancer. Clin Cancer Res 15:1452–1459
Geyer CE, Forster J, Lindquist D et al (2006) Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med 355:2733–2743
Glück S, Castrellon A (2009) Lapatinib plus capecitabine resolved human epidermal growth factor receptor 2-positive brain metastases. Am J Ther 16:585–590
Cameron D, Casey M, Press M et al (2008) A phase III randomized comparison of lapatinib plus capecitabine versus capecitabine alone in women with advanced breast cancer that has progressed on trastuzumab: updated efficacy and biomarker analyses. Breast Cancer Res Treat 112:533–543
Adamo V, Franchina T, Adamo B, Scandurra G, Scimone A (2006) Brain metastases in patients with non-small lung cancer: focus on the role of chemotherapy. Ann Oncol 17(Suppl 2):ii73––75
Bernardo G, Cuzzoni Q, Strada MR et al (2002) First-line chemotherapy with vinorelbine, gemcitabine, and carboplatin in the treatment of brain metastases from non-small-cell lung cancer: a phase II study. Cancer Invest 20:293–302
Robinet G, Thomas P, Breton JL et al (2001) Results of a phase III study of early versus delayed whole brain radiotherapy with concurrent cisplatin and vinorelbine combination in inoperable brain metastasis of non-small-cell lung cancer: Groupe Francais de Pneumo-Cancérologie (GFPC) protocol 95–1. Ann Oncol 12:59–67
Franciosi V, Cocconi G, Michiara M et al (1999) Front-line chemotherapy with cisplatin and etoposide for patients with brain metastases from breast carcinoma, nonsmall cell lung carcinoma, or malignant melanoma: a prospective study. Cancer 85:1599–1605
Malacarne P, Santini A, Maestri A (1996) Response of brain metastases from lung cancer to systemic chemotherapy with carboplatin and etoposide. Oncology 53:210–213
Kaba SE, Kyritsis AP, Hess K et al (1997) TPDC-FuHu chemotherapy for the treatment of recurrent metastatic brain tumors. J Clin Oncol 15:1063–1070
Twelves CJ, Souhami RL, Harper PG et al (1990) The response of cerebral metastases in small cell lung cancer to systemic chemotherapy. Br J Cancer 61:147–150
Lee JS, Murphy WK, Glisson BS et al (1989) Primary chemotherapy of brain metastasis in small-cell lung cancer. J Clin Oncol 7:916–922
Kristensen CA, Kristjansen PEG, Hansen HH (1992) Systemic chemotherapy of brain metastases from Small-Cell Lung Cancer: a review. J Clin Oncol 10:1498–15027
Cortes J, Rodriguez J, Aramendia JM et al (2003) Front-line paclitaxel/cisplatin-based chemotherapy in brain metastases from Non-Small-Cell Lung Cancer. Oncology 64:28–35
Postmus PE, Haaxmo-Reiche H, Smit EF et al (2000) Treatment of brain metastases of Small-Cell Lung Cancer: comparing teniposide and teniposide with whole-brain radiotherapy-a phase III study of the European Organization for the research and treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol 18:3400–3408
Newton HB, Slivka MA, Volpi C et al (2003) Intra-arterial carboplatin and intravenous etoposide for treatment of metastatic brain tumors. J Neurooncol 61:35–44
Christodoulou C, Bafaloukos D, Linardou H et al (2005) Temozolomide combined with cisplatin in patients with brain metastases from solid tumors: a Hellenic Cooperative Oncology Group phase II study. J Neurooncol 71:61–65
Moscetti L, Nelli F, Felici A et al (2006) Up-front chemotherapy and radiation treatment in newly diagnosed non-small cell lung cancer with brain metastases: survey by Outcome Research Network for Evaluation of treatment results in Oncology. Cancer 109:274–281
Omuro AM, Raizer JJ, Demopoulos A, Malkin M, Abrey LE (2006) Vinorelbine combined with a protracted course of temozolomide for recurrent brain metastases: a phase 1 trial. J Neurooncol 78:277–280
Minotti V, Crino L, Meacci ML et al (1998) Chemotherapy with cisplatin and teniposide for cerebral metastases in non-small cell lung cancer. Lung Cancer 20:93–98
Richards JM, Gale D, Mehta N, Lestingi T (1998) Combination of chemotherapy with Interleukin-2 and Interferon Alfa for the treatment of metastatic melanoma. J Clin Oncol 17:651–660
Bafaloukos D, Gogas H, Georgoulias V et al (2002) Temozolomide in combination with docetaxel in patients with advance melanoma: a phase II study of the Hellenic Cooperative Oncology Group. J Clin Oncol 20:420–425
Strauss SJ, Marples M, Napier MP, Meyer T, Boxall J, Rustin GJ (2003) A phase I (tumour site-specific) study of carboplatin and temozolomide in patients with advanced melanoma. Br J Cancer 89:1901–1905
Fetell MR, Grossman SA, Fisher JD et al (1997) Pre-irradiation paclitaxel in glioblastoma multiforme: efficacy, pharmacology, and drug interactions: new approaches to brain tumor therapy. Central Nervous System Consortium. J Clin Oncol 15:3121–3128
Fujita A, Fukuoka S, Takabatake H, Tagaki S, Sekine K (2000) Combination chemotherapy of cispllatin, ifosfamide, and irinotecan with rhG-CSF support in patients with brain metastases from non-small cell lung cancer. Oncology 59:291–295
Seute T, Leffers P, Wilmink JT, Ten Velde Guul PM, Twijnstra A (2006) Response of asymptomatic brain metastases from Small-Cell Lung Cancer to Systemic First-Line Chemotherapy. J Clin Oncol 24:2079–2083
Rosner D, Nemoto T, Lane WW (1986) Chemotherapy induces regression of brain metastases in breast carcinoma. Cancer 58:832–839
Eckardt JR, Martin KA, Schmidt AM et al (2002) A phase 1 trial of intravenous topotecan in combination with oral temozolomide daily times 5 every 28 days. Proc Am Soc Clin Oncol 21:83b, abst
Boogerd W, Dalesio O, Balis EM et al (1992) Response of brain metastases from breast cancer to systemic chemotherapy. Cancer 69:972–980
Antonadou D, Paraskevaidis M, Sarris G et al (2002) Phase II randomized trial of temozolomide and concurrent radiotherapy in patients with brain metastases. J Clin Oncol 20:3644–3650
Verger E, Gil M, Yaya R et al (2005) Temozolomide and concomitant whole brain radiotherapy in patients with brain metastases: a phase II randomized trial. Intern J Radiat Oncol Bio Phy 61:185–191
Margolin K, Atkins B, Thompson A et al (2002) Temozolomide and whole brain irradiation in melanoma metastatic to the brain: a phase II trial of the Cytokine Working Group. J Clin Oncol 128:214–218
Hofman M, Kiecker F, Wurm R et al (2006) Temozolomide with or without radiotherapy in melanoma with unresectable brain metastases. J Neurooncol 76:59–64
Ulrich J, Gademann G, Gollnick H (1999) Management of cerebral metastases from malignant melanoma: results of a combined, simultaneous treatment with fotemustine and irradiation. J Neurooncol 43:173–178
Mehta MP, Khuntia D (2005) Current strategies in whole-brain radiation therapy for brain metastases. Neurosurgery 57(suppl):33–44
Koay E, Sulman EP (2012) Management of brain metastasis: past lessons, modern management, and future considerations. Curr Oncol Rep 14:70–78
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Chamberlain, M.C. (2012). Is There a Role for Systemic Chemotherapy in the Treatment of Brain Metastases?. In: Palmieri, D. (eds) Central Nervous System Metastasis, the Biological Basis and Clinical Considerations. Cancer Metastasis - Biology and Treatment, vol 18. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5291-7_8
Download citation
DOI: https://doi.org/10.1007/978-94-007-5291-7_8
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-5290-0
Online ISBN: 978-94-007-5291-7
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)