Abstract
During the natural history of oncologic diseases, approximately 20–40% of patients affected by cancer will develop brain metastases. Non-small lung cancer, breast cancer, and melanoma are the primaries that are most likely to metastasize into the brain. To date, the role of Radiosurgery/Stereotactic Radiotherapy (SRS/SRT) without Whole brain irradiation (WBRT) is a well-recognized treatment option for patients with limited intracranial disease (1–4 BMs) and a life-expectancy of more than 3–6 months. In the current review, we focused on randomized studies that evaluate the potential benefit of radiosurgery/stereotactic radiotherapy for brain oligometastases. To date, no difference in overall survival has been observed between SRS/SRT alone compared to WBRT plus SRS. Notably, SRS alone achieved higher local control rates compared to WBRT. A possible strength of SRS adoption is the potential decreased neurocognitive impairment.
Highlights
During the natural history of oncologic diseases, approximately 20–40% of patients affected by cancer will develop brain metastases (BMs) [1]
SRS/stereotactic radiotherapy (SRT) procedures have certain characteristics: a welldefined target delineation by means of magnetic resonance imaging, a highly conformal target dose distribution, a steep dose gradient, accurate patient setup and delivery of a high dose of irradiation per fraction. The objectives of these SRS/SRT characteristics are mainly represented by the possibility to decrease the radiotherapy-related intracranial toxicity and to improve tumor control [36, 37]
Concerning the first clinical aspect, Brown et al published the results of a phase III trial in which patients with 1–3 BMs were randomized to receive SRS or SRS plus Whole brain irradiation (WBRT) [38]
Summary
During the natural history of oncologic diseases, approximately 20–40% of patients affected by cancer will develop brain metastases. Non-small lung cancer, breast cancer, and melanoma are the primaries that are most likely to metastasize into the brain. The role of Radiosurgery/Stereotactic Radiotherapy (SRS/SRT) without Whole brain irradiation (WBRT) is a well-recognized treatment option for patients with limited intracranial disease (1–4 BMs) and a life-expectancy of more than 3–6 months. We focused on randomized studies that evaluate the potential benefit of radiosurgery/stereotactic radiotherapy for brain oligometastases. No difference in overall survival has been observed between SRS/SRT alone compared to WBRT plus SRS. SRS alone achieved higher local control rates compared to WBRT. A possible strength of SRS adoption is the potential decreased neurocognitive impairment
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