Whole-Brain Radiation Therapy Versus Stereotactic Radiosurgery for Cerebral Metastases

Haley K Perlow; Khaled Dibs; Kevin Liu; William Jiang; Prajwal Rajappa; Dukagjin M Blakaj; Joshua Palmer; Raju R Raval

doi:10.1016/j.nec.2020.06.006

Whole-Brain Radiation Therapy Versus Stereotactic Radiosurgery for Cerebral Metastases

Neurosurg Clin N Am. 2020 Oct;31(4):565-573. doi: 10.1016/j.nec.2020.06.006.

Authors

Haley K Perlow¹, Khaled Dibs¹, Kevin Liu¹, William Jiang¹, Prajwal Rajappa², Dukagjin M Blakaj¹, Joshua Palmer¹, Raju R Raval³

Affiliations

¹ Department of Radiation Oncology, The James Cancer Hospital & Solove Research Institute Ohio State University Wexner Medical Center, 460 West 10th Avenue, Suite D252, Columbus, OH 43210, USA.
² Department of Radiation Oncology, The James Cancer Hospital & Solove Research Institute Ohio State University Wexner Medical Center, 460 West 10th Avenue, Suite D252, Columbus, OH 43210, USA; Department of Neurological Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
³ Department of Radiation Oncology, The James Cancer Hospital & Solove Research Institute Ohio State University Wexner Medical Center, 460 West 10th Avenue, Suite D252, Columbus, OH 43210, USA. Electronic address: Raju.Raval@osumc.edu.

PMID: 32921352
DOI: 10.1016/j.nec.2020.06.006

Abstract

Whole-brain radiation therapy (WBRT) was frequently used to treat brain metastases in the past. Stereotactic radiosurgery (SRS) is now generally preferred to WBRT for patients with limited brain metastases. SRS can also be used to treat extensive brain metastases (>10-15 metastases), and clinical trials are currently comparing WBRT with SRS for extensive disease. SRS may allow for an increased risk of radiation necrosis or leptomeningeal disease dissemination after treatment. Preoperative SRS and multifraction radiotherapy decrease the risk of these side effects and may soon become standard of care. Combining SRS with immune checkpoint inhibitors may improve patient outcomes.

Keywords: Brain metastases; Radiation; SRS; Stereotactic radiosurgery; WBRT; Whole-brain radiation therapy.

Publication types

Review

MeSH terms

Brain Neoplasms / therapy*
Clinical Decision-Making
Cranial Irradiation* / adverse effects
Humans
Radiosurgery* / adverse effects