PRO: Do We Still Need Whole-Brain Irradiation for Brain Metastases?

Cancers (Basel)

Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.

Published: June 2023

AI Article Synopsis

  • The study re-evaluates the role of whole-brain radiation therapy (WBRT) in treating brain metastases, given concerns about its neurocognitive side effects and limited effectiveness in local tumor control and overall survival.
  • It reviews evidence from 1990 to present, highlighting advancements like hippocampus-avoidance WBRT and combined approaches that have shown promise.
  • Modern WBRT techniques remain relevant, particularly for patients with multiple metastases, though future research is needed to clarify when to prioritize either WBRT or radiosurgery in treatment plans.*

Article Abstract

(1) Background: In recent decades, the use of whole-brain radiation therapy (WBRT) in the treatment of brain metastases has significantly decreased, with clinicians fearing adverse neurocognitive events and data showing limited efficacy regarding local tumor control and overall survival. The present study thus aimed to reassess the role that WBRT holds in the treatment of brain metastases. (2) Methods: This review summarizes the available evidence from 1990 until today supporting the use of WBRT, as well as new developments in WBRT and their clinical implications. (3) Results: While one to four brain metastases should be exclusively treated with radiosurgery, WBRT does remain an option for patients with multiple metastases. In particular, hippocampus-avoidance WBRT, WBRT with dose escalation to the metastases, and their combination have shown promising results and offer valid alternatives to local stereotactic radiotherapy. Ongoing and published prospective trials on the efficacy and toxicity of these new methods are presented. (4) Conclusions: Unlike conventional WBRT, which has limited indications, modern WBRT techniques continue to have a significant role to play in the treatment of multiple brain metastases. In which situations radiosurgery or WBRT should be the first option should be investigated in further studies. Until then, the therapeutic decision must be made individually depending on the oncological context.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10295923PMC
http://dx.doi.org/10.3390/cancers15123193DOI Listing

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