Management of brain XXXX .

@entity1 @entity410 @entity137 @entity2657 @entity101 @entity0 @entity1313 @entity5 @entity138 @entity16 @entity2971 @entity262 @entity51 @entity3 @entity151 @entity320 @entity2359
Brain @entity3 occur in 20-40% of @entity1 with @entity5 and their frequency has increased over time. Lung, breast and skin ( @entity320 ) are the commonest sources of brain @entity3 , and in up to 15% of @entity1 the primary site remains unknown. After the introduction of MRI, multiple lesions have outnumbered single lesions. Contrast-enhanced MRI is the gold standard for the diagnosis. There are no pathognomonic features on CT or MRI that distinguish brain @entity3 from primary @entity1313 or nonneoplastic conditions: therefore a tissue diagnosis by biopsy should be always obtained in @entity1 with unknown @entity5 before undergoing radiotherapy and/or chemotherapy. Some factors are prognostically important: a high Performance Status, a solitary brain metastasis, an absence of systemic @entity3 , a controlled @entity5 and a younger age. Based on these factors, subgroups of @entity1 with different prognosis have been identified (RPA class I, II, III). Symptomatic therapy includes corticosteroids to reduce @entity2657 and anticonvulsants to control @entity410 . In @entity1 with newly diagnosed brain @entity3 prophylactic anticonvulsants should not be used routinely. The combination of surgery and whole-brain radiotherapy (WBRT) is superior to WBRT alone for the treatment of single brain metastasis in @entity1 with limited or @entity262 and good @entity16 . Complete surgical resection allows a relief of intracranial @entity101 , @entity410 and focal @entity51 . Radiosurgery, alone or in conjunction with WBRT, yields results which are comparable to those reported after surgery followed by WBRT, provided that lesion's diameter does not exceed 3-3.5 cm. Radiosurgery offers the potential of treating @entity1 with surgically inaccessible @entity3 . Still controversial is the need for WBRT after surgery or radiosurgery: local control seems better with the combined approach, but overall survival does not improve. Late @entity2359 in long surviving @entity1 after WBRT is not negligible; to avoid this complication @entity1 with favorable prognostic factors must be treated with conventional schedules of @entity138 , and monitoring of cognitive functions is important. WBRT alone is the treatment of choice in @entity1 with single brain metastasis not amenable to surgery or radiosurgery, and with an active @entity262 , and in @entity1 with multiple brain @entity3 . A small subgroup of these latter may benefit from surgery. The response rate of brain @entity3 to chemotherapy is similar to the response rate of the @entity5 and extracranial @entity3 , some @entity5 types being more chemosensitive ( @entity151 , @entity0 , @entity2971 ). New radiosensitizers and @entity137 or cytostatic agents, and innovative technique of drug delivery are being investigated.
