The cure MK-1775 purchase algorithm for patients with BMs is extremely variable and depends on several factors such as primary histology and other clinical characteristics of patients. Moreover, though a multidisciplinary strategy is needed when approaching such complex patients, the lack of technical resources may influence the therapeutic decision of the treating physician. In fact, in clinical practice, the treatment of BMs is often planned on the basis of the resources available at each treating center. The incidence of BMs reported in our series of

patients for each tumor was similar to that reported in other studies [2]. In our analysis, breast cancer was the tumor with the longest time to brain recurrence (46 months), probably reflecting the advantages of an early diagnosis and the availability of effective treatments. In fact, anthracycline- and taxanes-including regimens as well as new hormonal and biologic agents have significantly increased disease-free and overall survival in early breast cancer patients potentially leading to a higher incidence of BMs [15–17]. Regardless CH5424802 purchase of

the treatment used for BMs, breast cancer showed the highest 2-year survival rate (36%). The dramatic reduction of survival at 2 years observed for NSCLC and melanoma might be due to poor control of either cranial and extracranial disease usually achieved in both malignancies, thus reflecting the intrinsic radio-resistance of their BMs [18] and Evodiamine the low systemic efficacy of medical therapies [19, 20]. Similarly to breast cancer, a long time to brain recurrence (42 months) was observed also for colorectal cancer. Nevertheless, only 18% of patients with BMs from colorectal cancer survived at 1 year (in contrast with a 1-year survival of 58% for breast cancer patients with BMs), indicating that in colorectal cancer brain spread probably represents a final event in the course

of the disease. In our series of patients, WBRT was the most used up-front therapy for BMs (about 50% of patients) followed by chemotherapy which was delivered in approximately one fourth of cases. The reason why many patients received chemotherapy as up-front treatment for BMs despite the fact that only 41% of patients suffered from multiple (> 3) brain lesions, can be explained by several reasons. Firstly, nearly all patients of our series had active systemic disease at the time of diagnosis of brain metastases. Secondly, about half of patients had no neurological symptoms, which might have favored physicians’ choice of using chemotherapy as up-front treatment for BMs along with the fact that an oncology unit was available in each institution.