In the appropriate circumstance, one symptomatic tumor may be removed while others may be treated with whole brain radiation therapy. Stereotactic radiation boost treatment is being investigated in addition to whole brain radiation. For some types of tumors, usually those sensitive to chemotherapy such as small cell carcinoma, chemotherapy may be an additional treatment to consider. Adjuncts to whole brain radiation therapy, such as RSR-13, an oxygen carrying compound, are currently in clinical trials. Treatment of recurrent brain metasteses can consist of surgery, radiosurgical boost, whole brain radiation alone, chemotherapy or a clinical trial for the treatment of recurrent brain metasteses.
Most tumors arising outside of the nervous system can travel to the area surrounding the spine.
The treatment of epidural metasteses depends on the type of tumor, number of tumors and the amount of systemic disease. Initial treatment may include surgery with local radiation therapy. Surgery is recommended if neurological damage is imminent or if the tumor type is unknow. Radiation therapy alone is appropriate for patients without significant neurological difficulty or for patients who cannot tolerate surgery. For tumors that are sensitive to chemotherapy, such as lymphoma, chemotherapy may be an alternative to radiation therapy.