Surgery is another important treatment modality for BMs, although current evidence suggests that it should be reserved to selected patients with single brain metastasis and favorable prognostic factors [10]. Regarding chemotherapy, its poor activity in cerebral metastases can only be partially attributed to the blood-brain barrier (BBB), that limits the penetration of some chemotherapeutic agents into thecentral nervous system (CNS). However, the mechanisms responsible for molecular

transportation across the BBB have been only partially elucidated. Moreover, the tumor-specific enhancing properties of agents selleckchem used in Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) also suggest that BBB might be partially disrupted

in patients with brain metastases. As a result, intracranial responses are observed in chemosensitive tumors [11] and new chemotherapeutic and biologic agents NVP-BSK805 in vivo show in the CNS an activity similar to that exhibited at extracranial sites [12, 13]. In the context of a multidisciplinary approach involving different specialists, namely oncologists, radiotherapists and neurologic surgeons, thoughtful appropriate observational studies are helpful to guide clinical management. On behalf of the Neuro-Oncology Group MEK activity Consortium for Outcome Research, we carried out a survey on cancer patients treated for BMs derived from solid tumors. Four different Italian institutions participated to the survey. Our aims were a) to evaluate in an unselected population Fenbendazole of patients the strategies commonly employed for the management of BMs b) to correlate the type of treatment with clinical outcome c) to define whether the unavailability

of local approaches (neurosurgery and SRS) at the referring centers would impact on disease outcome. Methods Cancer patients with BMs referring to four different Italian institution (“”Regina Elena”" National Cancer Institute in Rome, “”I.N.I.”" Hospital in Grottaferrata, “”Umberto I”" Hospital in Frosinone and “”Belcolle”" Hospital in Viterbo) were recruited for the survey. To be included, patients had to have received at least one treatment for brain metastases. The resources available at each institution are described in Table 1. Local treatments (neurosurgery and SRS) were available only in one center, while WBRT and chemotherapy were available in two and three centers respectively. Table 1 Availability of resources at each Institution Centre Neurosurgery SRS WBRT Chemotherapy Patients Cohort 1 a Yes Yes Yes Yes 235 A 2 b No No Yes Yes 28 B 3 c No No No Yes 16   4 d No No No Yes 11   aRegina Elena National Cancer Institute (Rome); bBelcolle Hospital (Viterbo); cI.N.I.