Metastatic Brain Tumors

The past two decades have seen a large increase in treatment options, resulting in longer life expectancy and better quality of life to a point where metastatic lesions are no longer the ma‐ jor cause of mortality in this patient group. This has made decision making on treatment mo‐ dality more complex. Evidence for local aggressive control through surgery and stereotactic radiosurgery (SRS) [3–5] has resulted in a paradigm shift since the mid 1990’s when whole brain radiation therapy (WBRT) was the mainstay of treatment. Now, treatment of metastat‐ ic tumors includes a full spectrum of medical providers including neurosurgeons, medical on‐ cologists, radiation oncologists, neurologists, and neuro-oncologists. This Chapter will focus on the contemporary management of metastatic brain tumors using surgery, radiosurgery, conventional radiation therapy, chemotherapy, steroids, anti-epileptics, and emerging modal‐ ities. Given the myriad of treatment options and the multiple providers utilizing them, the substantiation for these treatments are vital for the clinician to make an evidence-based deci‐ sion. The information in this chapter will not only serve to guide the clinician in treatment options, but also to focus the researcher on areas that need further investigation.