Evidence-Based Treatment of Primary and Recurrent Brain Metastasis

Brain metastases are the most common tumors of central nervous system. The main treatment of these tumors includes surgical resection, radiotherapy and chemotherapy. There are class I evidences supporting that the combination of surgical resection and whole brain radiation therapy is better than the other modalities. However, all these are not sufficient to prevent recurrences. It is said that one of the main cause of the recurrences of brain metastases is the infiltration of the tumor cells into the periglial tissue. For these, en block resection with peritumoral tissue is advised for primary brain metastasis in available cases by some authors. There is no consensus for treatment of these recurrent brain tumors. There is no evidence based treatment guideline for these tumors either. The clinical condition of the patient, the clinical findings of the recuurent tumor, the aim of the palliation in the patient, the symptom that require treatment in the patient are the subjects should be considered for making decision of treatment of the recurrent brain tumors. Repeated resection of the recurrent tumors is recommended in suitable patients.