Juniper Publishers-Cancer Therapy and Oncology

The Role of Radio Surgery in Brain Metastases Treatment – Attaining Local Control




Authored by  Or Cohen-Inbar

Brain metastases are a common cause of morbidity and mortality. Surgical resection (SR), Radiosurgery (SRS) and Whole brain radiotherapy (WBRT) are the main treatment modalities aimed at attaining local control. SR allows for tissue diagnosis and for a swifter symptomatic relief, yet surgical morbidity in these frail patients, continues to taint its advantages. SRS is an attractive treatment option for patients harboring a limited intracranial metastatic burden due to its single session, high dose, highly conformal nature. SRS has minimal side effects or time delay to starting systemic therapy as well. With regards to local control, reports from the last decade have shown good and comparable rates of SRS and SR, with lower morbidity in SRS and a swifter relief in SRS. A large body of evidence suggests WBRT should be used as an adjunct tool. As primary treatment, WBRT is inferior to SRS or SR in attaining local control. WBRT is reserved for lesions unsuitable for SRS or SR due to size, number or location constraints. Still, omitting WBRT as an adjunct tool after SR or SRS has led to worse local and distant intracranial control, with no influence on functional or overall survival.


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