Selected Bibliography

Bibliography of Medical Articles About Brain and Other Central Nervous System Metastases

This section offers citations and links to recent medical literature on brain and other CNS metastases, grouped into sections by the following topics:

Most of these citations link only to abstracts, which summarize findings but often do not provide important details.  Ways to get full text include 1) publicly accessible medical libraries; 2) staff at universities or teaching hospitals with subscriptions to the medical/scientific literature; or 3) sending an email request for a reprint to the corresponding author you will often find listed in the abstract. This usually works very well!

Read This!

As part of their recommendation that women with brain metastases be permitted to participate in Phase I clinical trials, neurosurgeons Nicholas Marko and Robert Weil, of the Cleveland Clinic, review and update the prognosis for brain metastasis patients. Dr. Weil is a member of our Center of Excellence. Some excerpts:

"The frequently held conception that the presence of BM (brain mets) portends imminent neurologic decline and impending death are predicated on outdated data. While WBRT and corticosteroid therapy was once the sole, palliative treatment strategy for patients with BM, the rapidly evolving, modern era of multimodality management of CNS (central nervous system) disease has afforded a nearly fourfold increase in the mean survival expectation of these patients over the past 15 years... Aggressive local therapy for BM has shifted the nature of morbidity and death of these patients, with the majority of those with advanced-stage cancer now dying from their primary disease rather than from their CNS metastases....In summary, modern, multimodality therapy for patients with BM has resulted in significant improvements in local control and overall survival, and CNS disease is no longer the primary determinant of premature debility or mortality."

"Patients with brain metastases in early-phase trials"
Nicholas F. Marko and Robert J. Weil
J. Nat. Rev. Clin. Oncol. 8, 390391 (2011); published online 17 May 2011;
Download free full text, with author and publisher's permission HERE

NOTE: Reading medical and scientific articles can be difficult for the layperson. Here are some other important things to keep in mind. Click here for definitions of some confusing terms.

  • Some of the articles group CNS metastases from different cancers together, making the findings difficult to interpret for breast cancer.
  • Some of the articles are dated. Some progress has been made that makes the mortality and toxicity look worse than they are in the present. Even a current study can be looking at patient outcomes from years earlier.
  • Median survival means that half of those being studied live longer than the median and half live less than the median. For example, a median survival of one year means that half will live more than a year, some much longer.
  • Many of the studies listed here are retrospective (data gathered from the past). If a study compares how women did with stereotactic radiosurgery (SRS) alone vs stereotactic radiosurgery plus whole-brain radiation, it is important to take into account that the women who received only SRS probably had a better prognosis from the outset. This biases the findings. Some treatment questions can only really be resolved with randomized clinical trials which are ongoing.