Cerebral metastasis: what is it and what is its treatment?

Brain metastasis It is the most frequent brain tumor And it's a challenge for doctors. They constitute about 90% of the total cases of brain tumors.

It is estimated that between 10 and 40% of cancer patients have brain metastases; its incidence is increasing given the higher average survival of cancer patients, thanks to current therapies.

Tumors have a different ability to metastasize in the brain and they must have the ability to penetrate the blood brain barrier, which is what covers and protects the brain.

Metastasis is a characteristic that cancer cells possess that It consists of the ability to invade both neighboring and distant tissues of the first tumor. That is, cancer cells can migrate to other parts of the body and cause another tumor.

The clinical metastasis of the brain is varied and depends on the affected site, as well as the associated seizure risks.

Causes of brain metastasis

Brain metastasis usually occurs by hematogenous spread, that is, because the cancer cells of the primary tumor they pass into the blood, reach the brain and spread.

In this sense, it is interesting that the distribution of brain metastases is proportional to blood flow of the area in question, being located according to the following percentages:

The first step for cells to spread through the brain is that they invade the arterial wall at the level of the first primary tumor. In this way, some cancer cells are allowed to shed and enter the bloodstream.

Then, the cell or cells that have passed into the blood, they have to be able to adhere to the vessels of the brain passing the blood brain barrier.

The blood brain barrier and the absence of a lymphatic system gives the brain significant protection against the entry of many drugs and microorganisms, but eventually it is not able to prevent the entry of certain cells.

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How do the blood brain barrier cross the neoplastic cells?

The mechanisms used by neoplastic cells to cross the blood brain barrier are a reason for study. However, already it has been shown that there are at least two mechanisms:

  • Para-cellular, that is, crossing it between the barrier cells: for this, the cells must destroy the joints between the cells and must have certain proteins and inflammatory mediators.
  • Trans-cellular or, which is the same, causing the direct death of the barrier cells.

What happens after having crossed the blood brain barrier?

Once they are inside the brain, the cells pass to the microvasculature of the same and from there they are extravased, that is, they leave towards the tissue.

Survival and proliferation from that moment on is dependent on the ability to maintain an adequate supply of oxygen and nutrients, which explains why these malignant cells stay very close to the blood vessels.

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Treatments of brain metastasis

Within the usual treatment, if the patient suffers a headache, an imaging study should be done in order to rule out complications that require surgical intervention.

As for the specific treatment of brain metastasis, we can mention the following options:

  • Surgical resection: It involves the removal of the tumor through small incisions. It is done by vitrectomy. It presents a series of advantages such as that it manages to remove the effect of the mass, eliminate the source of edema and improve overall survival compared to holocraneana radiation therapy alone.
  • Holocraneana radiotherapy: Historically, it has been considered as the treatment of choice when the tumor burden is high. It has also proven useful as an adjunct to surgical treatment, significantly reducing the incidence of recurrences after resection.
  • Stereotactic radiosurgery: consists of focally administering radiation to the tumor. It has shown better survival and lower recurrence in those patients with an injury; and also better local control, but not a significant difference in survival in those with 2 or 3 lesions.
  • Chemotherapy: Brain metastases are usually refractory to chemotherapy. However, the integration of new therapeutic alternatives, such as target agents and immune control point inhibitors, has intensified research in this area.


Brain metastases make up about 90% of the total cases of cancer in the brain. It is essential to establish a diagnosis as early as possible to try to stop the progression of the disease.

Today, there are different treatments that are getting better and better. However, brain metastasis is a very aggressive cancer and there is still much to investigate in this area.

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