Brain Metastases

  • Paul W. Sperduto
  • Laurie E. Gaspar
Part of the Medical Radiology book series (MEDRAD)


Brain metastases are a common problem historically associated with poor outcomes, however the past sense of therapeutic nihilism is no longer appropriate because we now understand prognosis and the factors determining prognosis vary widely by diagnosis. Fifty years of clinical trials have demonstrated a gradual shift in the cause of death from neurologic to non-neurologic (50 % neurologic in the early trials to less than 20 % in recent trials). This shift correlates with improvements in local control rates in the radiosurgery era. One-year local control with WBRT alone, SRS alone, and WBRT plus SRS is approximately 50 %, 70–80 %, and 80–90 %, respectively. Evidence-based guidelines and randomized trials are reviewed and elucidate the general principles of management, aiding the clinician regarding choice of treatment (surgery, stereotactic radiosurgery (SRS) and whole brain radiation therapy). Notably, 15 randomized trials of chemotherapy or radiosensitizers have failed to improve survival. On-going trials address quality-of-life and cognitive outcomes (i.e., the extent to which cognitive decline is due to tumor progression versus treatment-related toxicity). Better control of extra-cranial tumor will be necessary in order to improve overall survival for most patients


Brain Metastasis Stereotactic Body Radiation Therapy Radiation Therapy Oncology Group Whole Brain Radiation Therapy Radiation Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Minneapolis Radiation Oncology University of Minnesota, Gamma Knife CenterMinneapolis USA
  2. 2.University of ColoradoDenver USA

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