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Nat Rev Clin Oncol. 2014 Apr;11(4):203-22. doi: 10.1038/nrclinonc.2014.25. Epub 2014 Feb 25.

Current approaches to the treatment of metastatic brain tumours.

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Department of Hematology and Medical Oncology, Emory University, Atlanta, GA 30322, USA.
Department of Dermatology, Atlanta Veterans Administration Medical Center, Emory University, Atlanta, GA 30322, USA.
Department of Radiation Oncology, Emory University, Atlanta, GA 30322, USA.
Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, K-11, Detroit, MI 48202, USA.
Division of Cancer and Cell Biology, Translational Genomics Research Institute, 445 North 5th Street, Phoenix, AZ 85004, USA.
Division of Integrated Cancer Genomics, Translational Genomics Research Institute, 445 North 5th Street, Phoenix, AZ 85004, USA.
Iowa Spine and Brain Institute, 2710 St Francis Drive, Suite 110, Waterloo, IA 50702, USA.
Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA.
H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, 12902 Magnolia Drive, Tampa, FL 33612, USA.


Metastatic tumours involving the brain overshadow primary brain neoplasms in frequency and are an important complication in the overall management of many cancers. Importantly, advances are being made in understanding the molecular biology underlying the initial development and eventual proliferation of brain metastases. Surgery and radiation remain the cornerstones of the therapy for symptomatic lesions; however, image-based guidance is improving surgical technique to maximize the preservation of normal tissue, while more sophisticated approaches to radiation therapy are being used to minimize the long-standing concerns over the toxicity of whole-brain radiation protocols used in the past. Furthermore, the burgeoning knowledge of tumour biology has facilitated the entry of systemically administered therapies into the clinic. Responses to these targeted interventions have ranged from substantial toxicity with no control of disease to periods of useful tumour control with no decrement in performance status of the treated individual. This experience enables recognition of the limits of targeted therapy, but has also informed methods to optimize this approach. This Review focuses on the clinically relevant molecular biology of brain metastases, and summarizes the current applications of these data to imaging, surgery, radiation therapy, cytotoxic chemotherapy and targeted therapy.

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