Stereotactic radiosurgery alone for brain metastases

• Published in: The lancet oncology Vol. 16; no. 3; pp. 249 - 250
• Main Authors: Sahgal, Arjun, Larson, David, Knisely, Jonathan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2015; Elsevier Limited
• Subjects: Brain Neoplasms - mortality; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Chemotherapy; Cranial Irradiation; Hematology, Oncology and Palliative Medicine; Humans; Metastasis; Patient Selection; Patients; Quality of life; Radiosurgery; Radiotherapy, Adjuvant; Risk Factors; Toxicity; Treatment Outcome
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(14)71106-4

[...]current class 1 evidence has shown that WBRT on its own does not durably control brain metastases,1,2 and can compromise survival in some patients when given without surgery or SRS.2,3 Contemporary randomised trials have focused on SRS, with or without WBRT, in patients with few brain metastases.1 Findings from these trials have shown that adjuvant WBRT has significant harmful effects on quality of life and cognition.4,5 Trials assessing prophylactic WBRT in patients with high risk non-small cell lung cancer,6 the use of neuroprotective drugs with WBRT,7 and WBRT hippocampal avoidance8 confirm the reduction of cognitive scores with WBRT, thus strengthening the argument to avoid normal brain tissue radiation exposure. The noted benefits of WBRT avoidance in maintaining increased neurocognitive functioning, quality-of-life scores, and--now--extended survival do come at the expense of greater rates of intracranial relapse.1,9 This consequence highlights the importance of routine follow-up imaging and appropriate use of salvage therapies. [...]to be consistent with the evidence, it behooves us to routinely image all patients with brain metastases after treatment--local progression and new brain metastases can occur irrespective of what initial treatment is used.