Stereotactic radiosurgery in the management of brain metastases

Abstract

A treatment relying solely on stereotactic radiosurgery (SRS), with the omission of whole brain radiotherapy (WBRT), is now increasingly applied to the patients with brain metastases that are limited in number, however, it has not been reached a general agreement if patients really receive benefit from this strategy. In response to this situation, we, Japanese Radiation Oncology Study Group (JROSG), carried out a prospective randomized control trial in which SRS-alone approach was compared with WBRT+SRS for patients with 1-4 brain metastases. This study proved that there was no significant difference in survival, mode of death (neurologic versus systemic), and functional preservation rate between two treatment arms. However, the omission of WBRT significantly increased the frequency of brain tumor recurrence, and as a result, salvages brain treatments were more frequently required among patients allocated to SRS-alone arm. In the analyses of neurocognitive function, it was shown that the brain tumor recurrence as well as late radiation toxicities could be a cause of the deterioration of neurocognitive function. Those results indicate that SRS-alone treatment can be a treatment option for 1-4 brain metastases, however frequent monitoring of the brain tumor status should be warranted in order to detect recurrence of brain metastases before they became symptomatic.