In many patients with brain metastases, the primary therapeutic aim is symptom palliation and maintenance of neurologic function, but in a small selected cohort, long-term survival and even cure are possible. Central nervous system failures might develop after initial treatment, either locally (regrowth of a previously treated lesion), regionally (elsewhere in the brain parenchyma), or even in the form of leptomeningeal dissemination, the latter carrying the worst prognosis. Some of these failures will not require local therapy because they develop in the terminal phase of general cancer progression where active brain metastasis treatment is neither expected to prolong survival nor improve the patient’s quality of life. At the other end of the spectrum, patients with limited, brain-only, relapse require effective intracranial disease control as a prerequisite for extended survival. The present chapter reviews reirradiation with brachytherapy, stereotactic radiosurgery, fractionated stereotactic radiotherapy and whole-brain radiotherapy.
KeywordsBrain Metastasis Karnofsky Performance Status Radiation Therapy Oncology Group Recursive Partitioning Analysis Biologically Effective Dose
- Agboola O, Benoit B, Cross P et al (1998) Prognostic factors derived from recursive partitioning analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases. Int J Radiat Oncol Biol Phys 42:155–159CrossRefPubMedGoogle Scholar
- Brown PD, Asher AL, Ballman KV et al. (2015) NCCTG N0574 (Alliance): A phase III randomized trial of whole brain radiation therapy (WBRT) in addition to radiosurgery (SRS) in patients with 1 to 3 brain metastases. J Clin Oncol 33, (suppl; abstr LBA4).Google Scholar
- Guo S, Balagamwala EH, Reddy C et al (2014) Clinical and radiographic outcomes from repeat whole-brain radiation therapy for brain metastases in the age of stereotactic radiosurgery. Am J Clin Oncol, epubGoogle Scholar
- Nieder C, Leicht A, Motaref B, Nestle U, Niewald M, Schnabel K (1999) Late radiation toxicity after whole brain radiotherapy: the influence of antiepileptic drugs. Am J Clin Oncol. 22(6):573–9Google Scholar
- Regine WF, Scott C, Murray K, Curran W (2001) Neurocognitive outcome in brain metastases patients treated with accelerated-fractionation vs. accelerated-hyperfractionated radiotherapy: an analysis from Radiation Therapy Oncology Group Study 91-04. Int J Radiat Oncol Biol Phys 51:711–717CrossRefPubMedGoogle Scholar