Review

Role of stereotactic radiosurgery in patients with more than four brain metastases

Vikram Jairam

* Author for correspondence

Yale School of Medicine, Department of Therapeutic Radiology, New Haven, CT, USA. .

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Email the corresponding author at vikram.jairam@yale.edu

Veronica LS Chiang

Yale Cancer Center, New Haven, CT, USA

Yale School of Medicine, Department of Neurosurgery, New Haven, CT, USA

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James B Yu

Yale School of Medicine, Department of Therapeutic Radiology, New Haven, CT, USA

Yale Cancer Center, New Haven, CT, USA

Cancer Outcomes, Public Policy, & Effectiveness Research (COPPER) Center at Yale, New Haven, CT, USA

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Jonathan PS Knisely

Department of Radiation Medicine, North Shore-Long Island Jewish Health System & Hofstra-North Shore-LIJ School of Medicine, Manhasset, NY, USA

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Published Online:4 Mar 2013https://doi.org/10.2217/cns.13.4

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Abstract

SUMMARY For patients presenting with brain metastases, two methods of radiation treatment currently exist: stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT). SRS is a minimally invasive to noninvasive technique that delivers a high dose of ionizing radiation to a precisely defined focal target volume, whereas WBRT involves multiple smaller doses of radiation delivered to the whole brain. Evidence exists from randomized controlled trials for SRS in the treatment of patients with one to four brain metastases. Patients with more than four brain metastases generally receive WBRT, which can effectively treat undetected metastases and protect against intracranial relapse. However, WBRT has been associated with an increased potential for toxic neurocognitive side effects, including memory loss and early dementia, and does not provide 100% protection against relapse. For this reason, physicians at many medical centers are opting to use SRS as first-line treatment for patients with more than four brain metastases, despite evidence showing an increased rate of intracranial relapse compared with WBRT. In light of the evolving use of SRS, this review will examine the available reports on institutional trials and outcomes for patients with more than four brain metastases treated with SRS alone as first-line therapy.

Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

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