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Review
. 2021 Oct:156:93-108.
doi: 10.1016/j.ejca.2021.07.032. Epub 2021 Aug 20.

The evolving role of neurosurgery for central nervous system metastases in the era of personalized cancer therapy

Philipp Karschnia  1 , Emilie Le Rhun  2 , Michael A Vogelbaum  3 , Martin van den Bent  4 , Stefan J Grau  5 , Matthias Preusser  6 , Riccardo Soffietti  7 , Louisa von Baumgarten  1 , Manfred Westphal  8 , Michael Weller  9 , Joerg-Christian Tonn  10
Affiliations
Free article
Review

The evolving role of neurosurgery for central nervous system metastases in the era of personalized cancer therapy

Philipp Karschnia et al. Eur J Cancer. 2021 Oct.
Free article

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.

Keywords: CNS; Cerebral; Metastasis; Neurological surgery; Quality of life.

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Conflict of interest statement

Conflict of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Philipp Karschnia reports research grants from the ‘Support Program for Research and Teaching’ (FöFoLe) at the Ludwig-Maximilians-University Munich, the ‘Society for Research and Science of the LMU Faculty of Medicine’ (WiFoMed), the Friedrich Baur Foundation, and the ‘Familie Mehdorn’ Foundation. Emilie Le Rhun reports receiving honoraria for lectures or advisory board from AbbVie, Adastra, Daiichi Sankyo, LEO Pharma, Seagen, and Tocagen. Michael Vogelbaum reports indirect equity and patient royalty interests from Infuseon Therapeutics; honoraria from Celgene and Cellinta; and research grants from Celgene and Oncosynergy. Martin van den Bent reports consultant roles for Celgene, BMS, Agios, Boehringer, Abbvie, Bayer, Carthera, Nerviano, and Genenta. Matthias Preusser reports honoraria for lectures, consultation or advisory board participation from the following for-profit companies: Bayer, Bristol-Myers Squibb, Novartis, Gerson Lehrman Group (GLG), CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, Astra Zeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen, and Adastra. MP also reports supported clinical trials and contracted research conducted from the following for-profit companies with payments made to his institution: Böhringer-Ingelheim, Bristol-Myers Squibb, Roche, Daiichi Sankyo, Merck Sharp & Dome, Novocure, GlaxoSmithKline, and AbbVie. Michael Weller reports research grants from Abbvie, Adastra, Merck, Sharp & Dohme (MSD), Merck (EMD), Novocure, Piqur, and Roche; honoraria for lectures or advisory board participation or consulting from Abbvie, Adastra, Basilea, Bristol Meyer Squibb (BMS), Celgene, Merck, Sharp & Dohme (MSD), Merck (EMD), Novocure, Orbus, Roche, Tocagen, and yMabs. Joerg-Christian Tonn reports consultant/speaker honoraria from BrainLab and Carthera and royalties from Springer Publisher Intl. Stefan J. Grau, Riccardo Soffietti, Louisa von Baumgarten, and Manfred Westphal have no conflicts of interest.

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