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Brain Metastases

  • Chapter
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Controversies in Radiation Oncology

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Brain metastases (BM) cause significant morbidity and mortality, with profound personal and societal impact. Historically, surgery and whole-brain radiotherapy (WBRT) were the mainstays of management. WBRT alone has been shown to have limited role for durable local control, and there are concerns regarding its impact on quality of life (QoL) and neurocognitive function. Advances in systemic therapeutics have afforded improved control of extracranial disease and paved the way for improved survival outcomes. In parallel, the overarching goals of BM management are to provide durable intracranial control and good QoL, with minimal long-term toxicities, and, if possible, to prolong survival. However, there remain significant controversies within the oncology community about how these goals should be achieved. Herein, we will review various management strategies, including the role of stereotactic radiosurgery (SRS) and methods to mitigate long-term toxicity of WBRT.

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Authors and Affiliations

  1. Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore

    Balamurugan A. Vellayappan MB, BS, FRANZCR

  2. Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada

    Arjun Sahgal MD, FRCPC

  3. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA

    Kristin J. Redmond MD

  4. Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA

    Lia M. Halasz MD

  5. Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA

    Eric L. Chang MD, FASTRO

  6. Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA

    Simon S. Lo MD, FACR

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  1. Balamurugan A. Vellayappan MB, BS, FRANZCR
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  2. Arjun Sahgal MD, FRCPC
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  3. Kristin J. Redmond MD
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  4. Lia M. Halasz MD
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  5. Eric L. Chang MD, FASTRO
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  6. Simon S. Lo MD, FACR
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Correspondence to Simon S. Lo MD, FACR .

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Editors and Affiliations

  1. Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, USA

    Simon S. Lo

  2. Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA

    Bin S. Teh

  3. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

    Guo-Liang Jiang

  4. Department of Radiation Oncology, University of Washington, Seattle, WA, USA

    Nina A. Mayr

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Vellayappan, B.A., Sahgal, A., Redmond, K.J., Halasz, L.M., Chang, E.L., Lo, S.S. (2017). Brain Metastases. In: Lo, S., Teh, B., Jiang, GL., Mayr, N. (eds) Controversies in Radiation Oncology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_13

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