Nervous system metastases from systemic cancer

Abstract

Purpose of review: Metastatic complications affecting the nervous system, including brain metastases, leptomeningeal metastases, dural metastases, metastatic epidural spinal cord compression, intramedullary spinal cord metastases, and neoplastic plexopathy, are associated with significant morbidity and poor prognoses. Early recognition and management are vital to minimizing neurologic decline and maintaining quality of life.

Recent findings: Several recent randomized clinical trials in patients with brain metastases emphasize the importance of quality of life. Results from the European Organisation for Research and Treatment of Cancer (EORTC) 22952-26001 study suggest that adjuvant whole-brain radiation therapy after surgery or radiosurgery in patients with limited brain metastases may negatively impact some aspects of health-related quality of life, even if the negative effects are only transitory. In a separate study, Radiation Therapy Oncology Group (RTOG) 0614, memantine delayed cognitive decline in patients undergoing whole-brain radiation therapy for brain metastases.

Summary: This article summarizes the main clinical features of cancer metastases affecting the nervous system and highlights recent updates in treatment and symptomatic management.