Stereotactic radiosurgery for multiple brain metastases

Micro-Mini & Nano-Dosimetry & Innovative Technologies in Radiation Therapy

Yamada, Yoshiya^2 ; Lee, Anna^1

Department of Radiation Oncology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Ave, Brooklyn

NY

11203, United States^1

Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York

NY

10065, United States^2

关键词: Brain metastasis;    Leptomeningeal disease;    Multiple brain metastasis;    Neurocognitive functions;    Randomized trial;    Stereotactic radiosurgery;    Whole brain radiation therapies;    Whole-brain radiation;   

Others  :  https://iopscience.iop.org/article/10.1088/1742-6596/777/1/012031/pdf
DOI  :  10.1088/1742-6596/777/1/012031

来源: IOP

【 摘 要 】

Whole brain radiation therapy has been the traditional treatment of choice for patients with multiple brain metastases. Although stereotactic radiosurgery is widely accepted for the management to up to 4 brain metastases, its use is still controversial in cases of 5 or more brain metastases. Randomized trials have suggested that stereotactic radiosurgery alone is appropriate in up to 4 metastases without concomitant whole brain radiation. Level 1 evidence also suggests that withholding whole brain radiation may also reduce the impact of radiation on neurocognitive function and also may even offer a survival advantage. A recent analysis of a large multicentre prospective database has suggested that there are no differences in outcomes such as the likelihood of new metastasis or leptomeningeal disease in cases of 2-10 brain metastases, nor in overall survival. Hence in the era of prolonged survival with stage IV cancer, stereotactic radiosurgery is a reasonable alternative to whole brain radiation in order to minimize the impact of treatment upon quality of life without sacrificing overall survival.