Randomized trials have established the efficacy of focal treatment (either stereotactic radiosurgery or conventional surgery) for single brain metastases. In the past, adjuvant whole brain radiation therapy (WBRT) was routinely given with focal therapy. Recently, the utility of adjuvant WBRT has been called into question. This paper examines the scientific evidence and the arguments, pro and con, concerning the use of adjuvant WBRT in association with stereotactic radiosurgery or conventional surgery.
References
1.
PatchellR. A., TibbsP. A., WalshJ. W., DempseyR. J., MaruyamaY., KryscioR. J., MarkesberyW. R., MacdonaldJ. S., YoungB.A Randomized Trial of Surgery in the Treatment of Single Metastases to the Brain. N. Engl. J. Med. 322, 494–500 (1990).
2.
VechtC. J., Haaxma-ReicheH., NoordijkE. M., PadbergG. W., VoormolenJ. H., HoekstraF. H., TansJ. T., LambooijN., MetsaarsJ. A., WattendorffA. R.Treatment of Single Brain Metastasis: Radiotherapy Alone or Combined with Neurosurgery. Ann. Neurol. 33, 583–590 (1993).
3.
SperdutoP. W., ScottC., AndrewsD.Preliminary Report of RTOG-9508: A Phase HI Trial Comparing Whole Brain Irradiation Alone Versus Whole Brain Irradiation Plus Stereotactic Radiosurgery for Patients with Two or Three Brain Metastases. Int. J. Radiat. Oncol Biol. Phys. 48, 113 (2000).
4.
SperdutoP. W., ScottC., AndrewsD., SchellM., Werner-WasikM., DemasW., RyuJ. K., GasparL., CurranW.A Phase III Trial Comparing Whole Brain Irradiation Alone Versus Whole Brain Irradiation Plus Stereotactic Radiosurgery for Patients with One to Three Brain Metastases. Int. J. Radiat. Oncol. Phys. 51, 2S: 3 (2002).
5.
PatchellR. A., TibbsP. A., RegineW. F., DempseyR. J., MohiuddinM., KryscioR. J., MarkesberyW. R., FoonK. A., YoungB.Postoperative Radiotherapy in the Treatment of Single Metastases to the Brain: A Randomized Trial. J. Am. Med. Assoc. 280, 1485–1489 (1998).
6.
DeAngelisL. M., DelattreJ. Y., PosnerJ. B.Radiation-induced Dementia in Patients Cured of Brain Metastases. Neurology39, 789–796 (1989).
7.
RegineW. F., HuhnJ. L., PatchellR. A., St ClairW. H., StrottmannJ., MeigooniA., SandersM., YoungA. B.Risk of Symptomatic Brain Tumor Recurrence and Neurologic Deficit After Radiosurgery al in Patients with Newly Diagnosed Brain Metastases: Results and Implications. Int. J. Radiat. Oncol. Biol. Phys. 52, 333–338 (2002).
8.
RegineW. F., ScottC., MurrayK., CurranW.Neurocognitive Outcome in Brain Metastases Patients Treated with Accelerated-fraction vs. Accelerated-hyperfractionated Radiotherapy: An Analysis from Radiation Therapy Oncology Group Study 91–04. Int. J. Radiat. Oncol. Biol. Phys. 51, 711–717 (2001).
9.
TaylorB. V., BucknerJ. C., CascinoT. L., O'fallonJ. R., SchaeferP. L., DinapoliR. P., SchombergP.Effects of Radiation and Chemotherapy on Cognitive Function in Patients with High-grade Gliomas. J. Clin. Oncol. 16, 2195–2201 (1998).
10.
FlickingerJ. C., KondziolkaD., LunsfordL. D., CoffeyR. J., GoodmanM. L., ShawE. G., HudginsW. R., WeinerR., HarshG. R.4th, SneedP. K.Multi-institutional Experience with Stereotactic Radiosurgery for Solitary Brain Metastasis. Int. J. Radiat. Oncol. Biol. Phys. 28, 797–802 (1994).
11.
PirzkallA., DebusJ., LohrF., FussM., RheinB., Engenhart-CabillicR., WannenmacherM.Radiosurgery Alone or In Combination with Whole-brain Radiotherapy for Brain Metastases. J. Clin. Oncol. 16, 3563–3569 (1998).
12.
SneedP. K., LambornK. R., ForstnerJ. M., McDermottM. W., ChangS., ParkE., GutinP. H., PhillipsT. L., WaraW. M., LarsonD. A.Radiosurgery for Brain Metastases: Is Whole Brain Radiotherapy Necessary?Int. J. Radiat. Oncol. Biol. Phys. 43, 549–558 (1999).
13.
SneedP. K., SuhJ. H., GoetschS. J., SanghaviS. N., ChappellR., BuattiJ. M., RegineW. F., WeltmanE., KingV. J., BrenemanJ. C., SperdutoP. W., MehtaM. P.A Multi-institutional Review of Radiosurgery Alone vs Radiosurgery with Whole Brain Radiotherapy as the Initial Management of Brain Metastases. Int. J. Radiat. Oncol. Biol. Phys. 53, 519–526 (2002).
