Universität zu Köln

Karschnia, Philipp ORCID: 0000-0002-1254-5310, Le Rhun, Emilie, Vogelbaum, Michael A., Bent, Martin van den, Grau, Stefan J., Preusser, Matthias ORCID: 0000-0003-3541-2315, Soffietti, Riccardo ORCID: 0000-0002-9204-7038, von Baumgarten, Louisa ORCID: 0000-0002-6634-0927, Westphal, Manfred, Weller, Michael and Tonn, Joerg-Christian (2021). The evolving role of neurosurgery for central nervous system metastases in the era of personalized cancer therapy. Eur. J. Cancer, 156. S. 93 - 109. OXFORD: ELSEVIER SCI LTD. ISSN 1879-0852

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Abstract

Recent therapeutic advances involving the use of systemic targeted treatments and immunotherapeutic agents in patients with advanced cancers have translated into improved survival rates. Despite the emergence of such promising pharmacological therapies and extended survival, the frequency of metastases in the central nervous system has steadily increased. Effective medical and surgical therapies are available for many patients with brain metastases and need to be incorporated into multi-disciplinary care protocols. The role of neurosurgeons is evolving within these multi-disciplinary care teams. Surgical resection of brain metastases can provide immediate relief from neurological symptoms due to large lesions and provides the histopathological diagnosis in cases of no known primary malignancy. In situations where immunotherapy is part of the oncological treatment plan, surgery may be proposed for expeditious relief of edema to remove the need for steroids. In patients with multiple brain metastases and mixed response to therapeutics or radiosurgery, tumour resampling allows tissue analysis for druggable targets or to distinguish radiation effects from progression. Ventriculo-peritoneal shunting may improve quality of life in patients with hydrocephalus associated with leptomeningeal tumour dissemination and may allow for time to administer more therapy thus prolonging overall survival. Addressing the limited efficacy of many oncological drugs for brain metastases due to insufficient blood-brain barrier penetrance, clinical trial protocols in which surgical specimens are analysed after pre-surgical administration of therapeutics offer pharmacodynamic insights. Comprehensive neurosurgical assessment remains an integral element of multi-disciplinary oncological care of patients with brain metastases and is integral to tumour biology research and therapeutic advancement. 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Karschnia, Philipp UNSPECIFIED orcid.org/0000-0002-1254-5310 UNSPECIFIED Le Rhun, Emilie UNSPECIFIED UNSPECIFIED UNSPECIFIED Vogelbaum, Michael A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bent, Martin van den UNSPECIFIED UNSPECIFIED UNSPECIFIED Grau, Stefan J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Preusser, Matthias UNSPECIFIED orcid.org/0000-0003-3541-2315 UNSPECIFIED Soffietti, Riccardo UNSPECIFIED orcid.org/0000-0002-9204-7038 UNSPECIFIED von Baumgarten, Louisa UNSPECIFIED orcid.org/0000-0002-6634-0927 UNSPECIFIED Westphal, Manfred UNSPECIFIED UNSPECIFIED UNSPECIFIED Weller, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Tonn, Joerg-Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-600850
DOI:	10.1016/j.ejca.2021.07.032
Journal or Publication Title:	Eur. J. Cancer
Volume:	156
Page Range:	S. 93 - 109
Date:	2021
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1879-0852
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESECTED BRAIN METASTASES; STEREOTACTIC RADIOSURGERY; LOCAL RECURRENCE; BREAST-CANCER; VENTRICULOPERITONEAL SHUNT; CEREBRAL METASTASES; SURGICAL RESECTION; COMPARATIVE RISK; GROWTH-FACTOR; SOLID TUMORS Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60085