The role of stereotactic radiosurgery for multiple brain metastases in stable systemic disease: a review of the literature
Autor: | Siri S. Khalsa, Moshe Chinn, Jonathan H. Sherman, Max O. Krucoff |
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Rok vydání: | 2013 |
Předmět: |
medicine.medical_specialty
Systemic disease Neurology medicine.diagnostic_test Brain Neoplasms business.industry medicine.medical_treatment Cancer Interventional radiology Context (language use) Radiosurgery medicine.disease Combined Modality Therapy Surgery Radiation therapy Treatment Outcome medicine Humans Neurology (clinical) Neurosurgery Radiology Neoplasm Recurrence Local business |
Zdroj: | Acta Neurochirurgica. 155:1321-1328 |
ISSN: | 0942-0940 0001-6268 |
Popis: | Cancer patients with brain metastases display a median survival of only 1 to 2 months if left untreated. Although whole-brain radiation therapy (WBRT) has lengthened median patient survival, the long-term neurotoxic effects of WBRT have become a deterrent to its use in the context of stable systemic disease. Therefore, it is important to identify patients who might benefit from stereotactic radiosurgery (SRS) in order to delay or avoid WBRT. Here we present a review of the literature to elucidate the role of SRS in patients with multiple brain metastases.MEDLINE search for English-language articles from 1998 to 2012 describing survival or neurocognitive functioning of patients with multiple brain metastases treated with SRS, WBRT, or a combination.SRS monotherapy yields an equivalent survival with low risk of long-term neurotoxicity, but higher rate of recurrence, compared to WBRT or combined radiotherapy. Patients with ≤4 brain metastases or KPS ≥ 80 are expected to survive significantly longer than the onset time of prominent WBRT-induced neurocognitive decline.SRS, administered alone or adjuvant to surgical resection of symptomatic metastases, is preferred for patients with ≤4 brain metastases or KPS ≥ 80 to delay or avoid WBRT. WBRT can then be employed in the event of recurrence. WBRT with or without resection is preferred for patients with ≥5 brain metastases and KPS80, due to these patients' shorter survival and increased recurrence risk. SRS boost treatments can then be used in the event of poor tumor response or progression. |
Databáze: | OpenAIRE |
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