Radiation therapy for brain metastases.

Abstract

Metastasis to the brain is the most common intracranial tumor in adults. The most common sites of primary are lung, breast, melanoma, kidney, and colon. Common symptoms include headache, neurological deficit, and seizures. Parameters to predict prognosis include recursive partitioning analysis (RPA), score index for radiosurgery (SIR), and graded prognostic assessment (GPA). Standard treatment for patients with multiple metastases is whole-brain radiotherapy. For patients with single brain metastases, surgical resection followed by wholebrain radiotherapy can improve intracranial tumor control as compared with surgical resection alone, although no survival benefit has been demonstrated. For patients with one to four brain metastases, stereotactic radiosurgery (SRS) with or without whole-brain radiotherapy may be off ered, although the latter approach will result in an increased risk of intracranial failure, without impacting survival. Compared with 30 Gy in ten fractions, none of the other whole-brain radiotherapy regimens yields additional benefits. Neurocognitive defi cits can be caused by the presence of brain metastases, intracranial tumor progression, whole-brain radiotherapy, and chemotherapy (“chemobrain”).