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Shigeo Matsunaga, Takashi Shuto, Nobutaka Kawahara, Jun Suenaga, Shigeo Inomori and Hideyo Fujino

commonly thought to be a relatively radioresistant primary malignant tumor. 30 Brain metastases from colorectal cancer account for only 2%–3% of autopsy cases and 0.3%–9% of clinically diagnosed cases, 2–4 , 9 , 10 , 15 , 17 , 21 , 23 , 24 , 31 , 34 , 38 but the prevalence has been increasing because of better control of the primary cancer. Treatment of brain metastases depends on the systemic condition of the individual patient, but generally involves multimodal therapies including resection, WBRT, or SRS, singly or in combination. 1–3 , 5 , 6 , 8–11 , 15–17 , 21

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Benjamin Farnia, K. Ranh Voong, Paul D. Brown, Pamela K. Allen, Nandita Guha-Thakurta, Sujit S. Prabhu, Ganesh Rao, Qianghu Wang, Zhongxiang Zhao and Anita Mahajan

treatment records of 1962 patients with 5800 brain metastases who consecutively underwent SRS between June 2009 and October 2013. Intraventricular metastases were classified as primary if they arose within the ventricles or choroid plexus and secondary if they arose within the surrounding parenchyma but extended into the ventricular space ( Fig. 1 ). Our analysis included both types of lesion but only those secondary metastases in which more than half (50%) of the tumor volume protruded into the ventricular space. Two authors (N.G., A.M.) were the final arbiters with

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Hung-Chuan Pan, Jason Sheehan, Matei Stroila, Melita Steiner and Ladislau Steiner

B efore the advent of GKS, fractionated radiotherapy and resection were the mainstays of treatment for brain metastases. Now, GKS offers effective tumor control and a relatively long survival period for patients compared with the natural history of the disease. Moreover, it does so while causing minimal morbidity and essentially no deaths. Radiosurgery can be used to treat multiple metastases during the same procedure and permits treatment of deep deposits considered surgically inaccessible. 3, 4, 8–11, 16–18, 20, 23, 24 To date, however, the influence of

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Giacomo G. Vecil, Dima Suki, Marcos V. C. Maldaun, Frederick F. Lang and Raymond SaWaya

T raditionally patients with a limited number of brain metastases are treated surgically as the first line of therapy. The tumor recurrence rate (local or distant) in patients with a single brain lesion that had been initially treated with surgery has been reported to be approximately 31 to 48%. 27 When surgical intervention fails as the first modality, treatment of recurrent disease includes more surgery, SRS, and/or WBRT. 6, 27 The treatment options in this situation must be carefully considered because many patients will have already received WBRT

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Hideyuki Kano, Douglas Kondziolka, Oscar Zorro, Javier Lobato-Polo, John C. Flickinger and L. Dade Lunsford

B rain metastases occur in 20–40% of all patients with systemic cancer. 2 , 6 Approximately 30–40% of patients with systemic cancer harbor a solitary brain tumor. 11 , 12 , 17 Patients who have 1 or 2 brain metastases appear to have better outcomes than those with 3 or more brain metastases. 12 , 17 Treatment options include corticosteroids, WBRT, SRS, and/or resection, alone or in combination. Radiosurgery is frequently used to manage metastases as initial treatment or as adjuvant therapy to resection and/or WBRT. 16 Stereotactic radiosurgery alone is a

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Paul Rava, Kara Leonard, Shirin Sioshansi, Bruce Curran, David E. Wazer, G. Rees Cosgrove, Georg Norén and Jaroslaw T. Hepel

M ore than 1.5 million estimated new cases of cancer will be diagnosed in 2012, and 30%–40% of patients are expected to develop brain metastases during the course of their disease. These numbers probably underestimate the current impact of metastatic CNS disease. First, the availability and utilization of MRI provides for a sensitive, noninvasive study to detect small lesions. In addition, improved and novel systemic treatments continue to extend survival among patients with metastatic disease. In patients with single or symptomatic brain metastases

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Nicolas Dea, Martin Borduas, Brendan Kenny, David Fortin and David Mathieu

. A review of the recent literature showed no difference in survival and local control rates when comparing radiosurgery alone with resection plus radiation therapy of solitary brain metastases suitable for radiosurgery. 15 , 16 Metastases located in eloquent cerebral areas can cause considerable morbidity and may pose a significant surgical challenge. Even though the feasibility and safety of resection of lesions in eloquent areas has been studied, 1 , 3 , 17 , 23 to date no study has specifically focused on the safety and efficacy of GKS for metastases in

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Michael A. Garcia, Ann Lazar, Sai Duriseti, David R. Raleigh, Christopher P. Hess, Shannon E. Fogh, Igor J. Barani, Jean L. Nakamura, David A. Larson, Philip Theodosopoulos, Michael McDermott, Penny K. Sneed and Steve Braunstein

B rain metastases are a significant cause of morbidity and mortality among cancer patients. 12 , 24 The incidence of brain metastases has risen over the past 2 decades, and this increase has been attributed to increased utilization of brain MRI, 1 , 15 improved systemic oncological therapies, 20 and a rise in incidence of cancer diagnoses in an aging population. 21 , 27 Advancements in MRI technology and the development of specific protocols aimed at detecting brain metastases have led to improved diagnostic sensitivity and quantification of brain metastases

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Toru Serizawa, Yoshinori Higuchi, Osamu Nagano, Shinji Matsuda, Junichi Ono, Naokatsu Saeki, Tatsuo Hirai, Akifumi Miyakawa and Yuta Shibamoto

N eurological outcomes, such as preservation of neurological function 16 and prevention of neurological death, are regarded as the ideal end points for evaluating treatment results for patients with brain metastases. However, previous reports on grading systems for brain metastasis patients, such as recursive partitioning analysis (Gaspar et al., 3 1997), score index for stereotactic radiosurgery (SIR; Weltman et al., 18 2000), Basic Score for Brain Metastases (BSBM; Lorenzoni et al., 8 2004), graded prognostic assessment (GPA; Sperduto et al., 17 2008

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Nataniel H. Lester-Coll, Arie P. Dosoretz, William J. Magnuson, Maxwell S. Laurans, Veronica L. Chiang and James B. Yu

U p to 40% of cancer patients will develop brain metastases during the course of their disease. 9 Whole-brain radiation therapy (WBRT) has historically been used to treat brain metastases and is associated with high rates of intracranial control but often results in significant neurocognitive sequelae. 3 , 6 , 20 , 24 Three randomized controlled trials that evaluated stereotactic radiosurgery (SRS) versus SRS followed by WBRT for 1–4 brain metastases found that the addition of WBRT improved intracranial control and decreased the need for salvage therapies, but