
Contents
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Introduction Introduction
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Epidemiology Epidemiology
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Histopathology and molecular pathogenesis Histopathology and molecular pathogenesis
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Clinical presentation Clinical presentation
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Focal neurological symptoms Focal neurological symptoms
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Headache Headache
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Cognitive and behavioral changes Cognitive and behavioral changes
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Epilepsy Epilepsy
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Nausea and vomiting Nausea and vomiting
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Signs of increased intracranial pressure Signs of increased intracranial pressure
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Imaging Imaging
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Brain metastases Brain metastases
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Spine Spine
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Leptomeningeal metastases Leptomeningeal metastases
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Management Management
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Surgery Surgery
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The importance of patient stratification The importance of patient stratification
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Surgical considerations Surgical considerations
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Radiotherapy Radiotherapy
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Whole-brain radiotherapy Whole-brain radiotherapy
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Stereotactic radiotherapy Stereotactic radiotherapy
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Prophylactic cranial irradiation Prophylactic cranial irradiation
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Systemic pharmacotherapy Systemic pharmacotherapy
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Introduction Introduction
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Breast cancer Breast cancer
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HER2-positive breast cancer HER2-positive breast cancer
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Triple-negative breast cancer Triple-negative breast cancer
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Hormone receptor-positive breast cancer Hormone receptor-positive breast cancer
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Translational research in BM of breast cancer and future treatment Translational research in BM of breast cancer and future treatment
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Melanoma Melanoma
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BRAF/MEK inhibitors BRAF/MEK inhibitors
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Immune checkpoint inhibitors Immune checkpoint inhibitors
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Lung cancer Lung cancer
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NSCLC—EGFR mutation NSCLC—EGFR mutation
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EGFR tyrosine kinase inhibitors EGFR tyrosine kinase inhibitors
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NSCLC—ALK translocation NSCLC—ALK translocation
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NSCLC—rare oncogene drivers NSCLC—rare oncogene drivers
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Small cell lung cancer Small cell lung cancer
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Other tumors Other tumors
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Neurocognition, quality of life and palliative care, symptom management Neurocognition, quality of life and palliative care, symptom management
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Neurocognition Neurocognition
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Health-related quality of life Health-related quality of life
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Palliative care—symptom management Palliative care—symptom management
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Surveillance recommendations Surveillance recommendations
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Identification and commentary on EANO and NCCN treatment guidelines Identification and commentary on EANO and NCCN treatment guidelines
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EANO guidelines EANO guidelines
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NCCN guidelines NCCN guidelines
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Intramedullary spinal cord metastasis Intramedullary spinal cord metastasis
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Children Children
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Brain metastases in children Brain metastases in children
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Spinal cord metastases in children Spinal cord metastases in children
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References References
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13.1 Metastases to the brain and spinal cord parenchyma
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Published:April 2025
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Abstract
Brain metastases (BM) affect 10–30% of patients with cancer. Common clinical symptoms are headache, cognitive changes, focal neurological deficit, and epilepsy. Brain magnetic resonance imaging with gadolinium is recommended to detect all, including small, BM. Surgery should be considered for large BM with neurological symptoms, followed by postoperative radiotherapy of the resection cavity. Small (up to 3 cm) and a limited number of BM are usually treated with stereotactic radiation. Systemic pharmacotherapy options may be chemotherapy (breast cancer), targeted therapy (oncogene-driven cancers), or immunotherapy (immunogenic tumor types). Neurological signs and symptoms can negatively impact quality of life and neurocognition. Treatment decisions, as taken in a multidisciplinary neuro-oncology team, should always seek a balance between benefits of disease control and treatment toxicity. Patients with intramedullary spinal cord metastases usually present with back pain and signs of myelopathy. Palliative, fractionated radiotherapy can stabilize neurological function.
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