{"id":5218,"date":"2024-12-11T17:37:54","date_gmt":"2024-12-11T16:37:54","guid":{"rendered":"https:\/\/irccs.com\/patologie\/central-nervous-system-metastasis\/"},"modified":"2026-03-26T14:43:56","modified_gmt":"2026-03-26T13:43:56","slug":"central-nervous-system-metastasis","status":"publish","type":"pathology","link":"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/","title":{"rendered":"Central nervous system metastasis"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p><strong> Brain and spinal<\/strong><strong> metastases<\/strong>, as well as<strong> leptomeningeal metastases,<\/strong> represent the most frequent <strong>secondary tumors <\/strong>of the nervous system. These are lesions that <strong>do not originate from nerve cells<\/strong>, but develop as a result of the spread of cancer cells from other organs, such as lung, breast, kidney, or melanoma. These cells migrate through the blood or cerebrospinal fluid and settle in the brain, spinal cord, or leptomeninges (the membranes that line the brain and cord).<\/p>\n\n\n\n<p>In most cases, metastases are located in the cerebral hemispheres, more rarely in the cerebellum or brainstem.<br>The <strong>appearance <\/strong>can occur at different times: sometimes along with the diagnosis of the primary tumor, other times months or years after its treatment.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The numbers in Italy<\/h3>\n\n\n\n<p>In 2024, according to <a href=\"https:\/\/www.registri-tumori.it\/cms\/pubblicazioni\/i-numeri-del-cancro-italia-2023\"><strong>AIRTUM<\/strong> <\/a>(Italian Association of Cancer Registries), cancers of the central nervous system in Italy recorded about <strong>6,126 new diagnoses<\/strong> (3,480 men and 2,644 women).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Multidisciplinary management<\/h3>\n\n\n\n<p>At the Candiolo Institute, the management of nervous system metastases is coordinated by the <strong>Interdisciplinary Care Group (ICG)<\/strong>. The team includes medical oncologists, neurosurgeons, radiation oncologists, neurologists, anesthesiologists and rehabilitation specialists. This approach allows each case to be evaluated individually, choosing the most appropriate course of treatment, which may include surgery, <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/radiotherapy\/\" type=\"medical-area\" id=\"5104\">radiation therapy<\/a>, targeted drug therapies, chemotherapy, or supportive therapies. Thanks to advances in therapies, the<strong>prognosis <\/strong>of brain, spinal, and leptomeningeal metastases has <strong>improved significantly in recent years<\/strong>, allowing more effective control of the disease and a better quality of life for patients.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span>Symptoms<\/h2>\n\n\n\n<p>Symptoms <strong>vary depending on the site of<\/strong> the metastasis:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>brain:<\/strong> headaches, nausea, vomiting, visual disturbances, cognitive or motor impairments, seizures;<\/li>\n\n\n\n<li><strong>spinal cord:<\/strong> pain along the spine, muscle weakness, difficulty walking, altered sensitivity, problems with bowel or urinary function;<\/li>\n\n\n\n<li><strong>leptomeninges: <\/strong>widespread symptoms that may include headache, neck stiffness, nausea, multifocal neurological deficits.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk factors<\/h2>\n\n\n\n<p>Nervous system metastasis<strong> affects 20 to 40 percent of cancer patients who survive the primary disease<\/strong>. In more than half of the cases, the injuries are multiple. The incidence of these tumors has increased over time due to <strong>more accurate diagnostics<\/strong> and <strong>better treatments of primary tumors<\/strong>, which have lengthened patient survival, thereby increasing the likelihood of developing secondary brain or spinal metastases.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span>Diagnosis and examination<\/h2>\n\n\n\n<p>Patients referred to the multidisciplinary program are <strong>patients with solid or hematologic cancer <\/strong>who present with <strong>neurological symptoms\/signs<\/strong>. The diagnostic pathway may include the following tests:<\/p>\n\n\n\t<div id=\"block_69c5381b19fd1\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Magnetic Resonance Imaging<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">The examination of first choice is an MRI scan <\/span><b>without and with contrast medium<\/b><span style=\"font-weight: 400;\"> which, depending on the presumed site of the clinically based lesion(s), will be centered <\/span><b>on the skull<\/b><span style=\"font-weight: 400;\"> (suspected brain metastases) <\/span><b>or on the spine<\/b><span style=\"font-weight: 400;\"> (suspected vertebral or spinal metastases). <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">In case the clinical suspicion on the basis of cranial or spinal radicular nerve deficits is leptomeningeal metastasis MRI should <\/span><b>include the study of both the encephalon and the medulla<\/b><span style=\"font-weight: 400;\"> (i.e., study of the meninges of the entire CNS).<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">TC<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>CT with contrast medium alone is not sufficient to evaluate small or localized metastases in the brainstem, nor to detect nodular or linear lesions on the leptomeninges, particularly at the level of the cerebellum and spinal cord.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">PET<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><strong>Brain PET scan<\/strong> is particularly useful to distinguish between radionecrosis and tumor recurrence after radiosurgery treatments.<\/p>\n<p><strong>Total body PET<\/strong>, on the other hand, is used in the staging of disease at the systemic level and is especially crucial before deciding on access to local therapies such as radiation therapy or neurosurgery.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Rachicentesis<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<article class=\"text-token-text-primary w-full focus:outline-none scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]\" dir=\"auto\" tabindex=\"-1\" data-turn-id=\"4f013b01-e011-4fcf-b8f5-70617a8d3fdb\" data-testid=\"conversation-turn-174\" data-scroll-anchor=\"false\" data-turn=\"assistant\">\n<div class=\"text-base my-auto mx-auto [--thread-content-margin:--spacing(4)] thread-sm:[--thread-content-margin:--spacing(6)] thread-lg:[--thread-content-margin:--spacing(16)] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] thread-sm:[--thread-content-max-width:40rem] thread-lg:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" tabindex=\"-1\">\n<div class=\"flex max-w-full flex-col grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal [.text-message+&amp;]:mt-5\" dir=\"auto\" data-message-author-role=\"assistant\" data-message-id=\"4f013b01-e011-4fcf-b8f5-70617a8d3fdb\" data-message-model-slug=\"gpt-5-mini\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden first:pt-[3px]\">\n<div class=\"markdown prose dark:prose-invert w-full break-words light markdown-new-styling\">\n<p data-start=\"0\" data-end=\"295\" data-is-last-node=\"\" data-is-only-node=\"\">Cerebrospinal fluid analysis by spinal tap <strong>(CSF)<\/strong> is recommended when there is clinical or radiological suspicion of leptomeningeal metastasis. This examination, however, is not indicated for brain metastases and is contraindicated in the presence of spinal cord compression caused by metastases.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"flex min-h-[46px] justify-start\"><\/div>\n<\/div>\n<\/div>\n<\/article>\n<article class=\"text-token-text-primary w-full focus:outline-none scroll-mt-(--header-height)\" dir=\"auto\" tabindex=\"-1\" data-turn-id=\"2f927f72-616a-497b-a416-e49e7a2ea8ce\" data-testid=\"conversation-turn-175\" data-scroll-anchor=\"false\" data-turn=\"user\">\n<h5 class=\"sr-only\"><\/h5>\n<\/article>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\t<div id=\"block_69c5381b1a03c\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Neurosurgery<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"575\">Surgical resection of CNS metastases is a strategic intervention in specific situations.<\/p>\n<p data-start=\"0\" data-end=\"575\">For <strong>single brain metastases<\/strong> <strong>larger than 3 cm<\/strong> or <strong>located in the posterior fossa<\/strong> with mass effect, the intervention aims to reduce pressure on brain structures, relieve neurological symptoms, and allow reduction or discontinuation of steroid therapy. In selected cases, surgery may also be considered for lesions between 2 and 3 cm in size after multidisciplinary discussion.<\/p>\n<p data-start=\"577\" data-end=\"748\">Resection also has<strong> prognostic value<\/strong> when the metastasis is solitary, in the absence of active systemic disease or when the latter is completely controlled.<\/p>\n<p data-start=\"750\" data-end=\"1041\">In the case of <strong>multiple brain metastases<\/strong>, removal of the largest, edematous or symptomatic lesion may be indicated for palliative purposes before starting nonsurgical treatments. Postoperative MRI is critical to check for residual tumor.<\/p>\n<p data-start=\"1043\" data-end=\"1286\" data-is-last-node=\"\" data-is-only-node=\"\">For leptomeningeal metastases, the use of neurosurgery is limited and is mainly considered in cases of symptomatic secondary hydrocephalus in order to place a CSF shunt and relieve intracranial pressure.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Medical oncology<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"211\">In patients with brain metastases, drug treatment is planned considering the molecular and histological characteristics of the original tumor and previously administered therapies.<\/p>\n<p data-start=\"213\" data-end=\"369\">A key aspect is the collaboration with the radiation oncologist, which is necessary to define when and how to possibly combine with radiation therapy.<\/p>\n<p data-start=\"371\" data-end=\"562\">When a brain metastasis is surgically removed, it is useful to reevaluate the molecular profile of the tumor so as to better tailor any postoperative targeted therapies.<\/p>\n<p data-start=\"564\" data-end=\"796\" data-is-last-node=\"\" data-is-only-node=\"\">For leptomeningeal metastases, treatment options may include systemic treatments or administered directly into the CSF (intrathecal therapy), always after careful evaluation by the multidisciplinary team.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"202\">Radiation therapy for brain metastases can have several goals: to help after surgery, to attempt to eliminate the disease completely, or to relieve symptoms in more widespread cases.<\/p>\n<p data-start=\"204\" data-end=\"601\"><strong data-start=\"204\" data-end=\"262\">Radiotherapy after surgery (adjuvant):<\/strong> is given after tumor removal to &#8220;clean&#8221; the surgical bed and reduce the risk of the disease returning. The most widely used techniques, such as stereotactic or intensity-modulated radiotherapy (VMAT), allow precise targeting of the affected area while sparing healthy brain tissue as much as possible.<\/p>\n<p data-start=\"603\" data-end=\"848\"><strong data-start=\"603\" data-end=\"629\">Radical radiotherapy:<\/strong> aims to completely eliminate the metastasis. It can be done in one session (radiosurgery) or in a few split sessions, usually up to five, depending on the size and location of the lesion.<\/p>\n<p data-start=\"850\" data-end=\"1324\"><strong data-start=\"850\" data-end=\"894\">Palliative (pan-brain) radio<\/strong> therapy: when metastases have spread throughout the brain, radiotherapy is applied to the entire brain to reduce symptoms and help maintain quality of life. In selected patients with good general condition and limited disease burden, special techniques such as<strong data-start=\"1204\" data-end=\"1227\">hippocampal sparing<\/strong> can be used to protect the hippocampus, a part of the brain important for long-term memory.<\/p>\n<p data-start=\"1326\" data-end=\"1473\" data-is-last-node=\"\" data-is-only-node=\"\">This approach allows the disease to be treated effectively while minimizing possible side effects on healthy brain tissue.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">In the case of brain metastases, the <\/span><b>steroids<\/b><span style=\"font-weight: 400;\">, particularly dexamethasone (4 to 16 mg\/day depending on the severity of neurological symptoms) are indicated to control brain edema. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">Possible prophylactic use in asymptomatic patients who need to undertake radiosurgery is at the discretion of the radiotherapist.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In the case of leptomeningeal metastasis, steroids are generally of little use, whereas nonsteroidal anti-inflammatory drugs, even at high doses, have a better palliative effect on symptoms.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A <\/span><b>antiepileptic therapy<\/b><span style=\"font-weight: 400;\"> is required if patients have presented with seizures.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing support<\/h2>\n\n\n\n<p>At our institute, we guarantee <strong>constant support before, during and after treatment <\/strong>to accompany each patient throughout the entire course of treatment and recovery.<\/p>\n\n\n\t<div id=\"block_69c5381b1a085\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Managing side effects<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Treatment for encephalic metastases <strong>often<\/strong> involves <strong>side effects<\/strong> that impact quality of life more or less severely. However, they can be mitigated and in some cases prevented by specific treatments and\/or appropriate lifestyle.<\/p>\n<p><!-- \/wp:paragraph --> <!-- wp:paragraph --><\/p>\n<p>At the Candiolo Institute, the doctors and nurses of the multidisciplinary team are available to provide the patient with all the support he or she needs to manage the various side effects he or she will face in the course of treatment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Psychological support  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<h3><span style=\"font-weight: 400;\">The impact of cancer in a person&#8217;s life also affects the<\/span><b> psychological sphere:<\/b><span style=\"font-weight: 400;\"> falling ill with cancer is in fact always a <\/span><b>traumatic event<\/b><span style=\"font-weight: 400;\"> that affects all dimensions of the person and can generate anxiety, fear, anger, depression.<\/span><\/h3>\n<h3><span style=\"font-weight: 400;\">At the Candiolo Institute, alongside cutting-edge therapies, the treatment and care pathway always includes a<\/span><b> qualified psycho-oncological support <\/b><span style=\"font-weight: 400;\">that helps the patient cope positively not only with treatment but also with the delicate phase of physical and psychological recovery.<\/span><\/h3>\n<h3><b>It is also possible to participate in support groups <\/b><span style=\"font-weight: 400;\">psychological to compare with other people who have gone through or are going through the same experience.<\/span><\/h3>\n<p>&nbsp;<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct line to specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">To ensure <\/span><b>timely and direct support<\/b><span style=\"font-weight: 400;\"> and receive timely answers to concerns and questions, a dedicated helpline is in place at the Candiolo Institute for all patients.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">From Monday to Friday, from 8 a.m. to 5 p.m., you can <\/span><b>contact the secretariat of the <a href=\"https:\/\/irccs.com\/aree-mediche\/day-hospital-oncologico\/\">oncology day hospital<\/a><\/b><span style=\"font-weight: 400;\"> at 011.993.3775, reporting the need for urgent consultation.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">The patient will be <\/span><b>quickly put in touch with his or her medical specialist<\/b><span style=\"font-weight: 400;\">, to receive clear answers and immediate support.<\/span><\/h3>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Continuing care and palliative care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">The cancer patient is a person with <\/span><b>complex needs<\/b><span style=\"font-weight: 400;\"> that requires <\/span><b>multidisciplinary support<\/b><span style=\"font-weight: 400;\"> not only for the cancer disease, but also for all related issues.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">At the Candiolo Institute, patients who need or require it have access to <\/span><b>specialists in different areas<\/b><span style=\"font-weight: 400;\"> to receive nutritional support, physical therapy, pain therapy and management of other associated conditions.<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social work<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><span style=\"font-weight: 400;\">The Social Service Department of the Candiolo Institute conducts <\/span><b>information and orientation interviews to patients and their families<\/b><span style=\"font-weight: 400;\"> on how to access services in the area and how to obtain welfare and social security benefits provided by law (disability, benefits for aids and prostheses, work leave, etc.).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The service operates on Wednesdays and Fridays from 9 a.m. to 1 p.m. (phone: 011 9933059).<\/span><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Follow up<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"0\" data-end=\"236\">Follow-up after treatment is mainly based on performing <strong>periodic MRIs<\/strong>, usually every 3 to 4 months, to monitor the progress of the disease and possibly intercept early signs of recurrence.<\/p>\n<p data-start=\"238\" data-end=\"548\" data-is-last-node=\"\" data-is-only-node=\"\">In the case of leptomeningeal metastases, in addition to MRI, it may be necessary to perform spinal tap, which is the collection of cerebrospinal fluid. The frequency of this examination is not fixed, but is determined by specialists according to the clinical situation and the evolution of the disease.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"interdisciplinary-group\" class=\"h2_anchor\"><\/span>Interdisciplinary Group  <\/h2>\n\n\n\n<p>Every cancer requires, in all phases of disease management, a multidisciplinary approach that at the Candiolo Institute is guaranteed by a team of different specialists, belonging to the various clinical and surgical departments of the Institute: this team is called GIC (Interdisciplinary Care Group). The GIC ensures that each patient is taken care of throughout the diagnostic-therapeutic process, including prescribing and booking examinations and communicating with the patient and his or her family members. The GIC defines and shares a personalized care pathway for each patient, based not only on the type and stage of the tumor, but also on the patient&#8217;s own characteristics. The goal is to ensure that he or she has the best outcome from both an oncologic and functional standpoint and maintains a good quality of life.The Group also works closely with the Institute&#8217;s researchers to ensure that patients have rapid access to the latest research-produced innovations in screening, diagnosis and treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical divisions<\/h2>\n\n\n\n<p>The diagnostic and therapeutic pathway of metastases of the nervous system at Candiolo, which are very rarely neurosurgical in nature, is treated mainly with a radiotherapeutic and pharmacological approach, and may require the intervention of different specialists depending on the affected organ. The clinical divisions involved are:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>    <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/medical-oncology\/\">Medical Oncology<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/radiotherapy\/\">Radiotherapy<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/radiodiagnostics\/\">Radiodiagnostics<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/divisioni-cliniche\/nuclear-medicine\/\">Nuclear Medicine<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-studies\" class=\"h2_anchor\"><\/span>Clinical studies<\/h2>\n\n\n\n<p><strong>Several research projects<\/strong> dedicated to both brain and leptomeningeal metastases are active. These include groundbreaking studies on <strong>liquid biopsy<\/strong>, a technique for analyzing blood or cerebrospinal fluid for the presence of genetic material released by cancer cells. This approach could in the future facilitate earlier diagnosis, monitoring of the disease, and increasingly targeted choice of therapies.<\/p>\n\n\n\n<p><strong>In selected cases,<\/strong> patients may also have the opportunity to participate in clinical trials that aim to evaluate the efficacy and safety of new surgical techniques, drugs, or innovative therapeutic approaches. Participation in these studies represents an important opportunity to access cutting-edge treatments, always under close medical supervision.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why choose us<\/h2>\n\n\n\n<p>At Candiolo IRCCS Institute, every patient with CNS metastasis is<strong> followed according to highly specialized standards, <\/strong>thanks to the synergistic work of a dedicated Interdisciplinary Care Group (ICG).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical experience and tailored approach<\/h3>\n\n\n\n<p>Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of these cancers. Our<strong>experience<\/strong> enables us to deal with even the most complex situations, always with a personalized approach built on each patient&#8217;s clinical profile.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Imaging technologies and advanced diagnostics<\/h3>\n\n\n\n<p>Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to <strong>state-of-the-art imaging technologies<\/strong> that allow accurate assessment of the extent of the disease.<\/p>\n\n\n\n<p>In addition, the Institute offers <strong>advanced and sophisticated laboratory investigations<\/strong>, including molecular and genomic analyses, which are critical for identifying biological features of the tumor and guiding therapeutic decisions<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Minimally invasive surgery and multidisciplinarity<\/h3>\n\n\n\n<p><strong>When indicated, surgery is performed with minimally invasive techniques <\/strong>that reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical research and access to trials<\/h3>\n\n\n\n<p><strong>As an IRCCS<\/strong>, the Candiolo Institute<strong> combines clinical practice with an important mission toward scientific research.<\/strong> Patients can be evaluated for<a href=\"#studi-clinici\"><strong>inclusion in active clinical trials<\/strong>,<\/a> which provide a real opportunity to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Care and support every step of the way<\/h3>\n\n\n\n<p>The <strong><a href=\"#gruppo-interdisciplinare\">Interdisciplinary Care Team<\/a> assists the patient at every stage<\/strong>: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.<\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5218","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Central nervous system metastasis - Istituto di Candiolo<\/title>\n<meta name=\"description\" content=\"Central nervous system metastasis: find out about the advanced diagnosis and treatment pathway in Candiolo (Turin) and how to access it.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Central nervous system metastasis - 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