Gain in the brain: Improving diagnosis and treatment for patients with brain metastases

Brain metastases are a life-threatening diagnosis, associated with high morbidity and mortality. The landscape of diagnosis and treatment of brain metastases has changed drastically over the past decade.

More advanced imaging techniques are explored for their clinical potential, to improve diagnosis and follow-up of intracranial disease after the start of treatment. In this thesis, we researched the potential of glucoCEST MRI, an advanced imaging technique that can indirectly detect glucose concentration in cells. In the future, this metabolic imaging might aid in medical dilemmas such as distinguishing tumour progression from radiation necrosis.

In addition, this thesis describes several cohorts of patients in the Erasmus MC, diagnosed with brain metastases of melanoma and renal cell carcinoma. We assessed clinically relevant questions such as the role of screening, and the impact of novel systemic treatments on survival. In particular for melanoma, immune checkpoint inhibitors are proven to be effective in patients with brain metastases.