{"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":"2026-06-12T14:36:47","modified_gmt":"2026-06-12T12:36:47","slug":"central-nervous-system-metastasis","status":"publish","type":"pathology","link":"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/","title":{"rendered":"Central Nervous System Metastases"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Brain, spinal, and leptomeningeal metastases<\/strong> are the most common secondary tumors of the nervous system. These lesions do not originate from nerve cells but result from the spread of cancer cells from other organs, most commonly the <strong>lung, breast, kidney<\/strong>, or from <strong>melanoma<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cancer cells can spread through the <strong>bloodstream<\/strong> or <strong>cerebrospinal fluid<\/strong>, eventually reaching the <strong>brain, spinal cord<\/strong>, or <strong>leptomeninges<\/strong> (the membranes that surround the brain and spinal cord).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In most cases, metastases develop in the <strong>cerebral hemispheres<\/strong>, while involvement of the <strong>cerebellum<\/strong> or <strong>brainstem<\/strong> is less common.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Metastases may occur at different stages of the disease. In some patients, they are diagnosed at the same time as the primary tumor, while in others they may develop <strong>months or years after treatment<\/strong> of the primary cancer.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Numbers in Italy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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), approximately <strong>6,126 new cases<\/strong> of central nervous system cancers were diagnosed in Italy in 2024 (<strong>3,480 men and 2,644 women<\/strong>).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Multidisciplinary Management<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>Candiolo Cancer Institute<\/strong>, the management of central nervous system metastases is coordinated through the <strong><a href=\"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/#multi-disciplinary-team\">GIC<\/a> (Interdisciplinary Care Group)<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The multidisciplinary team includes <strong>medical oncologists, neurosurgeons, radiation oncologists, neurologists, anesthesiologists, and rehabilitation specialists<\/strong>. This integrated approach allows each case to be evaluated individually and supports the selection of the most appropriate treatment strategy, which may include <strong>surgery, <a href=\"https:\/\/irccs.com\/en\/medical-area\/radiotherapy\/\">radiation therapy<\/a>, targeted therapies, systemic therapy, or supportive care<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Thanks to advances in treatment, the prognosis of <strong>brain, spinal, and leptomeningeal metastases<\/strong> has improved significantly in recent years, enabling more effective disease control 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 class=\"wp-block-paragraph\">Symptoms vary according to the <strong>location <\/strong>of the metastasis.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Brain metastases:<\/strong> headaches, nausea, vomiting, visual disturbances, cognitive or motor impairments, seizures<\/li>\n\n\n\n<li><strong>Spinal cord metasteses:<\/strong> spinal pain, muscle weakness, difficulty walking, altered sensitivity, bowel or bladder dysfunction<\/li>\n\n\n\n<li><strong>Leptomeningeal Metastases: <\/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 class=\"wp-block-paragraph\">Central nervous system metastases occur in approximately <strong>20 to 40% of patients with cancer<\/strong>. In more than half of cases, <strong>multiple lesions<\/strong> are present.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The incidence of these metastases has increased over time, largely because of <strong>improvements in diagnostic techniques<\/strong> and <strong>more effective treatments for primary tumors<\/strong>, which have extended patient survival and consequently increased 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 class=\"wp-block-paragraph\">Patients referred to the <a href=\"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/#multi-disciplinary-team\">multidisciplinary<\/a> program are typically individuals with a <strong>solid or hematologic malignancy<\/strong> who develop <strong>neurological symptoms or signs<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnostic workup may include the following examinations:<\/p>\n\n\n\t<div id=\"block_6a2bfd5e387b3\" 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 class=\"isSelectedEnd\"><strong>Magnetic resonance imaging (MRI)<\/strong> is the <strong>first-line diagnostic examination<\/strong> for the evaluation of suspected central nervous system metastases.<\/p>\n<p class=\"isSelectedEnd\">MRI is performed <strong>with and without contrast enhancement<\/strong> and is targeted according to the suspected site of disease:<\/p>\n<ul data-spread=\"false\">\n<li><strong>Brain MRI<\/strong> in patients with suspected <strong>brain metastases<\/strong><\/li>\n<li><strong>Spinal MRI<\/strong> in patients with suspected <strong>vertebral or spinal metastases<\/strong><\/li>\n<\/ul>\n<p>When <strong>leptomeningeal metastasis<\/strong> is suspected based on <strong>cranial nerve deficits<\/strong> or <strong>spinal radicular symptoms<\/strong>, MRI should include evaluation of both the <strong>brain and spinal cord<\/strong>, allowing assessment of the <strong>meninges throughout the entire central nervous system<\/strong>.<\/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\">Computed Tomography (CT)<\/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 class=\"isSelectedEnd\"><strong>Contrast-enhanced computed tomography (CT)<\/strong> has limitations in the evaluation of central nervous system metastases and is <strong>not sufficiently sensitive<\/strong> for detecting <strong>small lesions<\/strong> or metastases located in the <strong>brainstem<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">CT is also less effective in identifying <strong>nodular or linear leptomeningeal lesions<\/strong>, particularly those involving the <strong>cerebellum<\/strong> and <strong>spinal cord<\/strong>.<\/p>\n<p>For these reasons, <strong>magnetic resonance imaging (MRI)<\/strong> remains the preferred imaging modality when central nervous system metastases are suspected.<\/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\">Positron Emission Tomography (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 class=\"isSelectedEnd\"><strong>Brain PET imaging<\/strong> is particularly useful for distinguishing <strong>radiation necrosis<\/strong> from <strong>tumor recurrence<\/strong> following <strong>stereotactic radiosurgery<\/strong> or other radiation treatments.<\/p>\n<p class=\"isSelectedEnd\"><strong>Whole-body PET imaging<\/strong> is used for <strong>systemic disease staging<\/strong> and plays an important role in assessing the extent of cancer beyond the central nervous system.<\/p>\n<p>This examination is particularly valuable before considering <strong>local treatments<\/strong>, such as <strong>radiation therapy<\/strong> or <strong>neurosurgery<\/strong>, as it helps guide treatment planning and patient selection.<\/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 (Lumbar Puncture)<\/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 class=\"isSelectedEnd\"><strong>Cerebrospinal fluid (CSF) analysis<\/strong> obtained through <strong>lumbar puncture<\/strong> is recommended when there is <strong>clinical or radiological suspicion of leptomeningeal metastasis<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">However, this procedure is <strong>not indicated for brain metastases<\/strong>.<\/p>\n<p>It is also <strong>contraindicated in cases of spinal cord compression due to metastases<\/strong>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\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_6a2bfd5e388ae\" 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 class=\"isSelectedEnd\"><strong>Surgical resection of central nervous system metastases<\/strong> is indicated in selected clinical situations as part of a <strong>multidisciplinary treatment strategy<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">In cases of a <strong>single brain metastasis larger than 3 cm<\/strong>, or lesions located in the <strong>posterior fossa with mass effect<\/strong>, surgery aims to <strong>reduce intracranial pressure<\/strong>, relieve <strong>neurological symptoms<\/strong>, and potentially allow <strong>reduction or discontinuation of corticosteroid therapy<\/strong>. In selected cases, resection may also be considered for lesions measuring <strong>2 to 3 cm<\/strong>, following multidisciplinary evaluation.<\/p>\n<p class=\"isSelectedEnd\">Surgical removal may also have <strong>prognostic relevance<\/strong> when the metastasis is <strong>solitary<\/strong>, in the absence of <strong>active systemic disease<\/strong>, or when systemic disease is <strong>fully controlled<\/strong>.<\/p>\n<p>In patients with <strong>multiple brain metastases<\/strong>, resection of the <strong>largest, edematous, or symptomatic lesion<\/strong> may be performed for <strong>palliative purposes<\/strong> prior to nonsurgical treatments. A <strong>postoperative MRI scan<\/strong> is essential to assess the presence of any <strong>residual tumor<\/strong>.<\/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 class=\"isSelectedEnd\">In patients with <strong>brain metastases<\/strong>, systemic therapy is planned according to the <strong>molecular and histological characteristics<\/strong> of the primary tumor, as well as any <strong>previous treatments received<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">A key aspect of management is close collaboration with the <strong>radiation oncologist<\/strong>, which is essential to determine <strong>if and how systemic therapy should be combined with radiotherapy<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">When a <strong>brain metastasis is surgically resected<\/strong>, reassessment of the <strong>molecular profile of the tumor<\/strong> may be useful to better tailor <strong>postoperative targeted therapies<\/strong>.<\/p>\n<p>In cases of <strong>leptomeningeal metastases<\/strong>, treatment options may include <strong>systemic therapies<\/strong> or <strong>intrathecal administration directly into the cerebrospinal fluid (CSF)<\/strong>. These approaches are always considered within a <strong>multidisciplinary evaluation<\/strong>.<\/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 class=\"isSelectedEnd\"><strong>Radiotherapy for brain metastases<\/strong> may have different objectives, including <strong>adjuvant treatment after surgery<\/strong>, <strong>radical treatment<\/strong>, or <strong>palliation of symptoms<\/strong> in more advanced disease.<\/p>\n<p class=\"isSelectedEnd\"><strong>Adjuvant Radiotherapy: <\/strong>Adjuvant radiotherapy is administered after <strong>surgical removal of the metastasis<\/strong> to treat the <strong>surgical bed<\/strong> and reduce the risk of <strong>local recurrence<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">Modern techniques such as <strong>stereotactic radiotherapy<\/strong> and <strong>intensity-modulated radiotherapy (VMAT)<\/strong> allow precise targeting of the treated area while <strong>sparing healthy brain tissue<\/strong> as much as possible.<\/p>\n<p class=\"isSelectedEnd\"><strong>Radical Radiotherapy: <\/strong>Radical radiotherapy aims to achieve <strong>complete local control of the metastasis<\/strong>. It can be delivered as a <strong>single session (radiosurgery)<\/strong> or in <strong>a few fractions, usually up to five<\/strong>, depending on the size and location of the lesion.<\/p>\n<p class=\"isSelectedEnd\"><strong>Palliative (Whole-Brain) Radiotherapy: <\/strong>In cases where metastases are <strong>diffuse throughout the brain<\/strong>, radiotherapy may be delivered to the <strong>entire brain<\/strong> to alleviate symptoms and preserve <strong>quality of life<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">In selected patients with <strong>good performance status<\/strong> and <strong>limited disease burden<\/strong>, techniques such as <strong>hippocampal sparing<\/strong> may be used to protect the <strong>hippocampus<\/strong>, a structure involved in <strong>long-term memory<\/strong>.<\/p>\n<p>This approach allows effective disease control while minimizing damage to <strong>healthy brain tissue<\/strong>.<\/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 class=\"isSelectedEnd\">In patients with <strong>brain metastases<\/strong>, <strong>corticosteroids<\/strong>, particularly <strong>dexamethasone (4 to 16 mg\/day depending on neurological symptom severity)<\/strong>, are indicated to control <strong>cerebral edema<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">The possible <strong>prophylactic use<\/strong> of steroids in <strong>asymptomatic patients undergoing radiosurgery<\/strong> is left to the discretion of the <strong>radiotherapist<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">In cases of <strong>leptomeningeal metastases<\/strong>, corticosteroids are generally of limited benefit, whereas <strong>nonsteroidal anti-inflammatory drugs (NSAIDs)<\/strong>, even at high doses, may provide better <strong>palliative symptom control<\/strong>.<\/p>\n<p><strong>Antiepileptic therapy<\/strong> is indicated in patients who present with <strong>seizures<\/strong>.<\/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 class=\"wp-block-paragraph\">At the <strong>Candiolo Cancer Institute<\/strong>, we provide continuous support before, during, and after treatment to accompany each patient throughout the entire treatment and recovery pathway.<\/p>\n\n\n\t<div id=\"block_6a2bfd5e389a2\" 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\">Management of 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 class=\"isSelectedEnd\">Treatment for <strong>brain metastases<\/strong> may be associated with side effects that can variably affect <strong>quality of life<\/strong>. However, these effects can often be <strong>mitigated or, in some cases, prevented<\/strong> through appropriate medical interventions and lifestyle measures.<\/p>\n<p>At the <strong>Candiolo Cancer Institute<\/strong>, physicians and nurses within the <strong>multidisciplinary team (GIC)<\/strong> provide continuous support to ensure that each patient receives the necessary care to manage the different side effects that may arise during 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<p data-start=\"30\" data-end=\"249\">The impact of cancer also extends to the\u00a0<strong data-start=\"71\" data-end=\"95\">psychological sphere<\/strong>. A cancer diagnosis is often a\u00a0<strong data-start=\"127\" data-end=\"146\">traumatic event<\/strong>\u00a0that affects all aspects of a person\u2019s life and may generate\u00a0<strong data-start=\"208\" data-end=\"248\">anxiety, fear, anger, and depression<\/strong>.<\/p>\n<p data-start=\"251\" data-end=\"527\">At the\u00a0<strong data-start=\"258\" data-end=\"287\">Canciolo Cancer Institute<\/strong>, alongside advanced medical therapies, the care pathway always includes\u00a0<strong data-start=\"360\" data-end=\"402\">specialized psycho-oncological support<\/strong>, helping patients cope not only with treatment but also with the delicate phases of\u00a0<strong data-start=\"487\" data-end=\"526\">physical and psychological recovery<\/strong>.<\/p>\n<p data-start=\"529\" data-end=\"690\" data-is-last-node=\"\" data-is-only-node=\"\">Patients may also participate in\u00a0<strong data-start=\"562\" data-end=\"594\">psychological support groups<\/strong>, where they can share experiences with others who are facing or have faced a similar condition.<\/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 Access 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 class=\"isSelectedEnd\">To ensure timely support and provide prompt answers to questions or concerns, the\u00a0<strong>Candiolo Cancer Institute<\/strong>\u00a0offers a dedicated assistance service for all patients.<\/p>\n<p class=\"isSelectedEnd\">From\u00a0<strong>Monday through Friday<\/strong>, between\u00a0<strong>8:00 a.m. and 5:00 p.m.<\/strong>, patients can contact the\u00a0<a href=\"https:\/\/irccs.com\/en\/medical-area\/oncology-day-hospital\/\">Oncology Day Hospital<\/a>\u00a0Secretariat at\u00a0<strong>+39 011 993 3775<\/strong>\u00a0to request an urgent consultation.<\/p>\n<p>Patients are promptly connected with their specialist physician, ensuring rapid access to expert advice, clear information, and immediate support when needed.<\/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 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 class=\"isSelectedEnd\">Cancer patients often have\u00a0<strong>complex needs<\/strong>\u00a0that extend beyond the treatment of the disease itself and require comprehensive,<strong>\u00a0multidisciplinary care.<\/strong><\/p>\n<p class=\"isSelectedEnd\">At the\u00a0<strong>Candiolo Cancer Institute<\/strong>, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.<\/p>\n<p>The goal is to\u00a0<strong>improve quality of life, promote overall well-being, and provide comprehensive care<\/strong>\u00a0tailored to each patient\u2019s individual needs.<\/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 Services<\/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=\"26\" data-end=\"278\">The Social Work Service at the Candiolo Cancer Institute provides\u00a0<strong>information, guidance, and support to patients and their families<\/strong>\u00a0regarding access to community services and the welfare and social security benefits available under current legislation.<\/p>\n<p data-start=\"280\" data-end=\"491\">During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.<\/p>\n<p data-start=\"493\" data-end=\"621\" data-is-last-node=\"\" data-is-only-node=\"\">The service is available on\u00a0<strong data-start=\"521\" data-end=\"575\">Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m.<\/strong>\u00a0and can be contacted at\u00a0<strong data-start=\"600\" data-end=\"620\">+39 011 993 3059<\/strong>.<\/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 class=\"isSelectedEnd\">Follow-up after treatment is mainly based on <strong>periodic magnetic resonance imaging (MRI)<\/strong>, usually every <strong>3 to 4 months<\/strong>, to monitor disease status and detect any <strong>early signs of recurrence<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">In cases of <strong>leptomeningeal metastases<\/strong>, in addition to MRI, a <strong>lumbar puncture (spinal tap)<\/strong> may be required to collect and analyze <strong>cerebrospinal fluid (CSF)<\/strong>.<\/p>\n<p>The frequency of this procedure is <strong>not fixed<\/strong> and is determined by the <strong>specialist team<\/strong> based on the patient\u2019s <strong>clinical condition<\/strong> and the <strong>evolution of the disease<\/strong>.<\/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=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span>Multi Disciplinary Team<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every cancer requires a&nbsp;<strong>multidisciplinary approach<\/strong>&nbsp;at all stages of disease management. At the Candiolo Cancer Institute, this is provided by a team of specialists from various clinical and surgical departments, known as the&nbsp;<strong>GIC<\/strong>, Interdisciplinary Care Group (or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/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 class=\"wp-block-paragraph\">The <strong>diagnostic and therapeutic pathway for central nervous system metastases at the Candiolo Cancer Institute<\/strong> is managed primarily through <strong>radiotherapy and systemic pharmacological treatments<\/strong>, while <strong>neurosurgical intervention is required only in selected and rare cases<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The pathway involves the collaboration of multiple specialists, depending on the <strong>site of disease involvement<\/strong>, and includes several clinical divisions:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>    <a href=\"https:\/\/irccs.com\/en\/medical-area\/medical-oncology\/\">Medical Oncology<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/medical-area\/radiotherapy\/\">Radiotherapy<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/medical-area\/radiodiagnostics\/\">Radiodiagnostics<\/a><\/li>\n\n\n\n<li>    <a href=\"https:\/\/irccs.com\/en\/medical-area\/nuclear-medicine\/\">Nuclear Medicine<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"research-and-clinical-trials\" class=\"h2_anchor\"><\/span>Research and Clinical Trials<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Several research projects dedicated to both <strong>brain metastases<\/strong> and <strong>leptomeningeal metastases<\/strong> are currently active at the <strong>Candiolo Cancer Institute<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These include innovative studies on <strong>liquid biopsy<\/strong>, a technique used to analyze <strong>blood or cerebrospinal fluid (CSF)<\/strong> for genetic material released by cancer cells. In the future, this approach may support <strong>earlier diagnosis<\/strong>, <strong>disease monitoring<\/strong>, and more <strong>precise selection of targeted therapies<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In selected cases, patients may also have the opportunity to participate in <strong>clinical trials<\/strong> evaluating the <strong>efficacy and safety of new surgical techniques, drugs, or other innovative treatments<\/strong>. Participation in these studies offers access to <strong>cutting-edge therapeutic options<\/strong>, always under <strong>close medical supervision<\/strong>.<\/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 class=\"wp-block-paragraph\">At <strong>the Candiolo Cancer Institute<\/strong>, every patient with <strong>central nervous system (CNS) metastases<\/strong> is managed according to <strong>highly specialized standards<\/strong>, thanks to the coordinated work of a dedicated <strong><a href=\"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/#multi-disciplinary-team\">Interdisciplinary Care Group<\/a> (GIC)<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical Experience and Personalized Approach<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Due to the high volume of cases treated each year, the <strong>Candiolo Cancer Institute<\/strong> serves as a <strong>national reference center<\/strong> for these tumors. This experience allows the team to manage even the most complex clinical situations, always applying a <strong>personalized approach<\/strong> based on each patient\u2019s clinical profile.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to&nbsp;<strong>state-of-the-art imaging technologies<\/strong>, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Advanced laboratory tests<\/strong>, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Minimally Invasive Surgical Techniques and Multidisciplinarity<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">When appropriate, surgeries are performed using\u00a0<strong>minimally invasive<\/strong>, laparoscopic or robotic\u00a0<strong>techniques<\/strong>. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma.\u00a0<strong>Benefits<\/strong>\u00a0to the patient include\u00a0<strong>shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical Research and Access to Trials<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), the Candiolo Cancer Institute combines clinical care with a strong focus on scientific research. Patients can be considered for<a href=\"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/#research-and-clinical-trials\">\u00a0<strong>participation in active clinical trials<\/strong><\/a>, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Care and Support Every Step of the Way<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/irccs.com\/en\/pathology\/central-nervous-system-metastasis\/#multi-disciplinary-team\">The Interdisciplinary Care Group<\/a>\u00a0(GIC or MDT)\u00a0<strong>supports the patient at every stage<\/strong>: from diagnosis, through treatment, to follow-up. Special attention is paid to<strong>\u00a0nutritional support, psychological health and reintegration into daily life.<\/strong>\u00a0The organization of checkups, examinations, and treatment is designed to ensure\u00a0<strong>continuity, serenity, and a humane, caring<\/strong>\u00a0approach to each patient\u2019s needs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-5218","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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