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Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery?

Benötigen Patienten mit einer limitierten Zahl von Hirnmetastasen eine Ganzhirnbestrahlung zusätzlich zur Radiochirurgie?

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Abstract

Background

About 40% of patients with brain metastases have a very limited number of lesions and may be candidates for radiosurgery. Radiosurgery alone is superior to whole-brain radiotherapy (WBRT) alone for control of treated and new brain metastases. In patients with a good performance status, radiosurgery also resulted in better survival. However, the question is whether the results of radiosurgery alone can be further improved with additional WBRT.

Methods

Information for this review was compiled by searching the PubMed and MEDLINE databases. Very important published meeting abstracts were also considered.

Results

Based on both retrospective and prospective studies, the addition of WBRT to radiosurgery improved control of treated and new brain metastases but not survival. However, because a recurrence within the brain has a negative impact on neurocognitive function, it is important to achieve long-term control of brain metastases.

Conclusion

The addition of WBRT provides significant benefits. Further randomized studies including adequate assessment of neurocognitive function and a follow-up period of at least 2 years are needed to help customize the treatment for individual patients.

Zusammenfassung

Hintergrund

Etwa 40% der Patienten mit Hirnmetastasen haben eine sehr geringe Zahl von Läsionen und sind mögliche Kandidaten für die Radiochirurgie. Die alleinige Radiochirurgie ist der alleinigen Ganzhirnbestrahlung („whole-brain radiotherapy“, WBRT) hinsichtlich der Kontrolle behandelter und neuer Hirnmetastasen überlegen. Bei Patienten in gutem Allgemeinzustand zeigte sich auch ein besseres Gesamtüberleben. Es stellt sich die Frage, ob sich die Ergebnisse der alleinigen Radiochirurgie durch eine zusätzliche WBRT weiter verbessern lassen.

Methoden

Die Informationen für diese Übersichtsarbeit wurden durch eine Recherche der Datenbanken von PubMed und MEDLINE gewonnen. Sehr wichtige publizierte Kongressbeiträge wurden ebenfalls berücksichtigt.

Ergebnisse

Gemäß retrospektiver und prospektiver Studien führte die zusätzliche WBRT zu einer verbesserten Kontrolle sowohl der behandelten als auch möglicher neuer Hirnmetastasen, nicht aber zu einer Verbesserung des Gesamtüberlebens. Da ein intrazerebrales Rezidiv einen negativen Einfluss auf die neurokognitive Funktion der Patienten hat, ist eine Langzeitkontrolle von Hirnmetastasen von Bedeutung.

Schlussfolgerung

Die zusätzliche WBRT bietet signifikante Vorteile. Allerdings sind weitere randomisierte Studien erforderlich, um die Therapie besser auf den einzelnen Patienten abstimmen zu können. Bei derartigen Studien ist eine adäquate Erfassung der neurokognitiven Funktion unerlässlich, ebenso eine Nachbeobachtungszeit von mindestens 2 Jahren.

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Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany

    D. Rades

  2. Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, U.S.A.

    S.E. Schild

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  1. D. Rades
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  2. S.E. Schild
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Correspondence to D. Rades.

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Rades, D., Schild, S. Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery?. Strahlenther Onkol 188, 702–706 (2012). https://doi.org/10.1007/s00066-012-0093-4

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  • DOI: https://doi.org/10.1007/s00066-012-0093-4

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