Management of central nervous system metastases

Central nervous system (CNS) metastases are divided into brain metastasis and intramedullary spinal cord metastasis (ISCM). Although the blood-brain barrier (BBB) and blood-spinal barrier (BSB) protect the brain and spinal cord, metastases occur when these barriers break under abnormal conditions. Brain metastasis accounts for the largest number of brain tumors, however, ISCM rarely occurs. For brain metastasis, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), surgery, and chemotherapy can be considered, and for ISCM, radiotherapy (RT), surgery, Cyberknife SRS, and chemotherapy can be considered. As treatment options vary depending on the patient's life expectancy, performance status (PF), extent and number of metastases, and the type of primary cancer, careful patient evaluation should be performed prior to treatment of CNS metastases. Keywords: Brain; Central nervous system; Metastasis; Intramedullary spinal cord.