Current advances in understanding and managing secondary brain metastasis.

Metastatic brain tumors are the number one cause of intracranial neoplasms in adults and are associated with higher morbidity and mortality. The frequency of metastatic brain tumors is increasing because of improved survival in cancer patients. The molecular mechanism of brain metastasis is complex and not completely known. Vasogenic edema produced by tumor-derived VEGF is responsible for clinical symptoms. Dexamethasone remains the mainstay of medical management with not completely known mechanisms of action. Surgery and radiation are the main treatment modalities for metastatic brain tumors. Systemic chemotherapy has a very limited role in treatment of these tumors. Leptomeningeal metastasis is associated with extremely poor outcome.