Curing brain metastases

Clinical & Experimental Metastasis, Nov 2017

Rahul Jandial

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Curing brain metastases

Curing brain metastases 0 Division of Neurosurgery, City of Hope , Duarte, CA , USA 1 Rahul Jandial Vol.:(011233456789) - Cancers that invade the brain are universally fatal. The corrosive nature of invasive cancers on the delicate neurologic framework generates harrowing neurologic deficits that can be devastating on quality of life of our cancer patients. Despite significant advances in the diagnosis and management of brain metastases, poor prognoses are inevitable even with when applying the best standard treatment strategies. This sobering fact is an ugly confession that we are still far from winning the battle against cancer metastasis in the central nervous system (CNS). This special issue of Clinical and Experimental Metastasis is devoted to reporting the advancements in the battle against cancer metastases to the brain. Experiments as early as 1889 have discovered the exploitation of cancer cells within the central nervous system. The first article of this special issue is a report by Waters et al. where the past accomplishments and the historical basis of oncologic discovery is described as a launching pad for present and future research applications [ 1 ]. The milestones in the scientific basis of metastasis are highlighted, and are directly honored by inspiring basic sciences research on the pathophysiologic mechanisms of metastasis in today’s laboratories. Research into the molecular mechanisms of brain metastasis are ongoing, and may hold the keys to success in treating and preventing cancer’s grip. The next article by Hoshide et al. detail the neural niche, the unique landscape of the central nervous system, and the mechanisms facilitate cancer spread and survival [ 2 ]. Mysteries of the neural niche are soon becoming the mechanisms by which metastatic cancers can be cured—even prevented. As we understand more about the neural niche, it may become possible to design strategies to target the maladaptive metastatic mechanisms within this physiologic habitat. Metastatic cancers are known to demonstrate different metabolic behavior compared to their primary counterparts. While much is still needed to be known to undoubtedly connect the mechanisms of biochemical metabolism to cerebral metastasis, the ability to detect the accumulation or exhaustion of biochemical metabolites have been a topic of recent research. In the next review, Ciminera et al. [ 3 ] discuss the metabolic derangements occur with breast cancer, lung cancer, and melanomas in the context of brain metastases, and what they mean in terms of new treatment strategies. The understanding of the variety of surgical strategies and their associated outcomes have enabled neurosurgeons to perform the most effective surgery possible, thus reducing collateral injuries that once made surgery an dangerous endeavor. In this special issue, Ferguson et al. describe the updates with surgical standard of care with regards to metastatic tumors within the CNS [ 4 ]. Refining the art of surgical technique through technology reduces operation-related morbidity to the point where the surgeon no longer becomes more dangerous than the cancer, empowering neurosurgeons to treat without fear of administering undue harm. The advancements of targeted- and immune-therapies have given hope with regards to a new type of therapy for cancer cure. In a review by Nam et al. the theory and application of targeted and immunotherapy will be discussed with respect to CNS-involved metastatic cancers [ 5 ]. The use of engineered antibodies recruits the body’s own immune system to battle metastatic cancers. This tailored approach is relatively nascent with regards to cancer treatment strategies, but has risen in becoming the standard of care in certain applications. Radiotherapeutic management is an essential component in the management of brain metastases. In the last review of this special issue, Thiagarajan et  al. [ 6 ] report on the advances in whole brain radiation and stereotactic radiation in the treatment of brain metastases. The current landscape of radiotherapeutic options are described, and the future of radiation treatment is presented. In summary, this Brain Metastasis special issue of Clinical and Experimental Metastasis provides a state of the art update on the current understanding of the mechanisms of metastasis and the treatment paradigms by which they can be managed. We hope that this special issue is a call-to-arms to all scientists and physicians to inspire further discoveries in the cure for cancers that invade the brain. 1. Waters JD , Hoshide R , Jandial R ( 2017 ) Historical perspectives on the biology of brain metastasis . Clin Exp Metastasis . https:// 2. Hoshide R , Jandial R ( 2017 ) The role of the neural niche in brain metastasis . Clin Exp Metastasis . s10585-017-9857-7 3. Ciminera A , Jandial R , Termini J ( 2017 ) Metabolic advantages and vulnerabilities in brain metastases . Clin Exp Metastasis . 4. Ferguson SD et al. ( 2017 ) Neurosurgical management of brain metastases . Clin Exp Metastasis . s10585-017-9860-z 5. Nam JY , O'Brien BJ ( 2017 ) Current chemotherapeutic regimens for brain metastases treatment . Clin Exp Metastasis . https://doi. org/10.1007/s10585-017-9861-y 6. Thiagarajan A , Yamada Y ( 2017 ) Radiobiology and radiotherapy of brain metastases . Clin Exp Metastasis . s10585-017-9865-7

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Rahul Jandial. Curing brain metastases, Clinical & Experimental Metastasis, 2017, 1-2, DOI: 10.1007/s10585-017-9866-6