TOPIC REVIEW Modern management of rare brain metastases in adults Matthias J. Krammer • Andre Tomasino • David B. Schul • Sabrina T. Astner • Michael P. Meier • Christianto B. Lumenta Received: 11 December 2010 / Accepted: 22 May 2011 / Published online: 21 June 2011 Ó Springer Science+Business Media, LLC. 2011 Abstract Brain metastases (BM) represent the main cause of intracranial neoplasms in adults, while being rel- atively less common in children. Today, better treatment options of the primary malignancy lead to higher remission rates as well as prolonged stable clinical conditions. This may in part explain the increased incidence of BM. Mor- bidity and mortality rates in patients with malignancies deteriorate significantly in cases of metastatic involvement of the central nervous system. Nowadays, especially modern management using surgical, medical, and radio- therapeutic options for treatment of BM tends to improve survival rates and enhance quality of life. Nonetheless, almost all treatment options are considered as palliative. In this review, we outline current knowledge of the incidence, diagnostic facilities, and therapeutic management of rare BM, with consideration of the basic aspects of the primary malignancy. Keywords Brain metastasis Á Rare Á Management Á Surgery Á Radiosurgery Abbreviations 5-FU 5-Fluorouracil ACNU 1-(4-Amino-2-methyl-5-pyrimidinyl)-methyl-3- (2-chloroethyl)-3-nitrosourea hydrochloride BM Brain metastases CNS Central nervous system CT Computer tomography CTX Chemotherapy CUP Cancer of unknown primary EC Esophageal carcinoma EMC Endometrial cancer EOC Epithelial ovarian cancer FIGO Fe ´de ´ration Internationale de Gyne ´cologie et d’Obste ´trique GC Gastric cancer GIT Gastrointestinal tumor HCC Hepatocellular carcinoma KPS Karnofsky performance status MRI Magnetic resonance imaging MTX Methotrexate PRC Prostate carcinoma PSA Prostate-specific antigen PTC Parathyroid carcinoma RAI Radioactive iodine RPA Recursive partitioning analysis RS Radiosurgery TC Thyroid carcinoma WBRT Whole-brain radiotherapy WHO World Health Organization Introduction Recent publications report incidence of BM in 10–15% of all patients with malignancies [1] and up to 25% of all M. J. Krammer Á A. Tomasino Á D. B. Schul Á M. P. Meier Á C. B. Lumenta (&) Academic Teaching Hospital Munich Bogenhausen, Department of Neurological Surgery, Technical University of Munich, Englschalkinger Str. 77, 81925 Munich, Germany e-mail: C.Lumenta@extern.lrz-muenchen.de S. T. Astner Department of Radiotherapy and Radiooncology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany 123 J Neurooncol (2011) 105:9–25 DOI 10.1007/s11060-011-0613-6