Age-old misconceptions could be a blockade in the path of research and treatment for patients with cancer metastases to the brain, warns a new study.
Douglas Kondziolka of NYU Langone Medical Center in the US and co-authors have identified some issues that may be standing in the way of optimal clinical management for patients with cancer that has spread to the brain from other sites.
Brain metastases are a major problem in cancer treatment.
"Especially in this era of increasingly personalised medicine, one-size-fits-all thinking is improper, especially for a diagnostic entity as wide and varied as brain metastasis," the researchers wrote.
The first misconception is assuming that "all histologies are created equal" - that the type of cancer doesn't matter once it has spread to the brain.
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Likewise, there's no basis for the assumption that the number of brain metastases is the sole factor determining patient outcome.
Rather, Kondziolka believes, the focus should be on the total tumour burden, including the size as well as the number of metastases.
Similarly, some doctors hold the misconception that there's no such thing as a single metastasis - that if one lesion is present, there must be others as well.
But that is contrary to strong evidence that treatment for single brain metastasis can improve tumour control and patient survival.
Doctors may also believe that treatment with whole-brain radiation therapy (WBRT) inevitably leads to decline in cognitive (intellectual) function.
Researchers emphasised that, as for any treatment, the risks and benefits of WBRT must be considered for each individual patient.
Finally, there is an outdated assumption that since most brain metastases are symptomatic, there is no major benefit of screening tests for early detection.
But with increased use of magnetic resonance imaging, metastases are now being detected before they cause any symptoms.
Previous studies of larger, symptomatic metastases may not apply to these smaller, asymptomatic lesions.
The findings appeared in the journal Neurosurgery.
