Neurosurgical management of brain metastases in the era of modern oncology

Abstract

Brain metastases arise when cancer cells spread to the brain from primary tumors located elsewhere in the body, such as the lungs, breasts, or skin. They represent the most common type of brain tumor, yet historically have received relatively limited scientific attention.

This dissertation explores how the management of brain metastases has evolved in response to recent advances in systemic cancer therapies, including immunotherapy and targeted agents. These developments have led to prolonged survival in cancer patients, resulting in an increased incidence of brain metastases and a growing importance of local treatments such as neurosurgery and radiotherapy.

The research evaluates the role of neurosurgical intervention across diverse patient populations, including those beyond traditional surgical indications—such as individuals with multiple or recurrent metastases. In addition, it investigates how surgery can be integrated with immunotherapy, and identifies key unanswered questions in current neurosurgical guidelines, which were largely established prior to the advent of modern oncological treatments.

The findings of this dissertation support more individualized treatment strategies, contributing to personalized care that minimizes both over- and undertreatment. Ultimately, the results offer a foundation for improved clinical guidelines and more tailored therapeutic decision-making in patients with brain metastases.