scholarly journals Does Stereotactic Radiosurgery Have a Role in the Management of Patients Presenting With 4 or More Brain Metastases?

Neurosurgery ◽  
2018 ◽  
Vol 84 (3) ◽  
pp. 558-566 ◽  
Author(s):  
Michael H Soike ◽  
Ryan T Hughes ◽  
Michael Farris ◽  
Emory R McTyre ◽  
Christina K Cramer ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Performance Status ◽  
Phase Iii ◽  
Whole Brain Radiation ◽  
Multiple Phase ◽  
Phase Iii Trials ◽  
Prospective Trials ◽  
Level I ◽  
Brain Radiation

Abstract Stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) are effective treatments for management of brain metastases. Prospective trials comparing the 2 modalities in patients with fewer than 4 brain metastases demonstrate that overall survival (OS) is similar. Intracranial failure is more common after SRS, while WBRT is associated with neurocognitive decline. As technology has advanced, fewer technical obstacles remain for treating patients with 4 or more brain metastases with SRS, but level I data supporting its use are lacking.  Observational prospective studies and retrospective series indicate that in patients with 4 or more brain metastases, performance status, total volume of intracranial disease, histology, and rate of development of new brain metastases predict outcomes more accurately than the number of brain metastases. It may be reasonable to initially offer SRS to some patients with 4 or more brain metastases. Initiating therapy with SRS avoids the acute and late sequelae of WBRT. Multiple phase III trials of SRS vs WBRT, both currently open or under development, are directly comparing quality of life and OS for patients with 4 or more brain metastases to help answer the question of SRS appropriateness for these patients.

scholarly journals A Review of Stereotactic Radiosurgery in the Management of Brain Metastases

2003 ◽  
Vol 2 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Paul W. Sperduto
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Clinical Judgment ◽  
Randomized Trials ◽  
Performance Status ◽  
Poor Performance ◽  
Mass Effect ◽  
Poor Performance Status ◽  
Whole Brain Radiation ◽  
Brain Radiation

This review addresses the epidemiology, historical reports, current issues, data and controversies involved in the management of brain metastases. The literature regarding surgery, whole brain radiation therapy, stereotactic radiosurgery or some combination of those treatments is discussed as well as issues of cost-effectiveness. Ongoing prospective randomized trials will further elucidate the optimal management for patients with brain metastases. Until those data are available, clinicians are encouraged to apply the existing data reviewed here in conjunction with best clinical judgment. A brief clinical guide is as follows. Patients with a solitary metastasis in an operable location and symptomatic mass effect should undergo surgery. Patients with poor performance status (KPS < 70) or more than three brain metastases should receive WBRT alone. Patients with 1-3 brain metastases and KPS ≥ 70, should receive WBRT + SRS. If the patient refuses WBRT or needs salvage after WBRT, then SRS alone is appropriate. Clinicians should not be too dogmatic and should always apply the best clinical judgment.

Current Management of Brain Metastases, With a Focus on Systemic Options

2005 ◽  
Vol 23 (25) ◽  
pp. 6207-6219 ◽  
Author(s):  
Corey J. Langer ◽  
Minesh P. Mehta
Keyword(s):  
Brain Metastases ◽  
Anticancer Agents ◽  
Clinical Investigation ◽  
Treatment Options ◽  
Mass Effect ◽  
Current Treatment ◽  
Phase Iii ◽  
Whole Brain Radiation ◽  
Phase Iii Trials ◽  
Antiepileptic Medications

Brain metastases are an important sequelae of many types of cancer, most commonly lung cancer. Current treatment options include whole-brain radiation therapy (WBRT), surgical resection, stereotactic radiosurgery, and chemotherapy. Corticosteroids and antiepileptic medications are commonly used for palliation of mass effect and seizures, respectively. The overall median survival is only 4 months after WBRT. Combined-modality strategies of WBRT with either chemotherapy or novel anticancer agents are under clinical investigation. Promising results have been obtained with several experimental agents and confirmatory phase III trials are underway. Although improvement in overall survival has not been seen universally, reduction in death due to progression of brain metastases and prolongation of the time to neurologic and neurocognitive progression have been reported in selected series. On the basis of these findings, it might be possible to identify new agents that may enhance the efficacy of WBRT.

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