Effects Of Whole Brain Radiotherapy Research Articles

Radiation Induced Alopecia: An Under-Appreciated Side Effect of Whole Brain Radiotherapy and Strategies to Ameliorate it

Radiation Induced Alopecia: An Under-Appreciated Side Effect of Whole Brain Radiotherapy and Strategies to Ameliorate it

Effects of Whole-Brain Radiation Therapy and Other Factors on Survival in Patients with Brain Metastases From Lung Cancer

Effects of Whole-Brain Radiation Therapy and Other Factors on Survival in Patients with Brain Metastases From Lung Cancer

Whole Brain Radiation Therapy Improves Overall and Intracranial Progression-Free Survivals in Breast Cancer Patients With Brain Metastases in the Setting of Systemic Treatments

To evaluate overall (OS) and intracranial progression-free survival (PFS) effects of whole-brain radiotherapy (WBRT) in breast cancer (BC) patients with brain metastases (BM) in setting of systemic treatments. A retrospective analysis of 105 consecutive female patients admitted for BM from BC between 2013 and 2015 at a single institution was conducted. Patient and treatment characteristics were collected and survival data till December 1 2016 were calculated. Local radiotherapy (RT) modalities were classified: none, <30, 30-39 and ≥40 Gy of WBRT; none, <50 and ≥60 Gy of largest BM tumor site dose; gamma-knife/SRS use or not. Cox proportional hazard regression models were used to estimate the independent effects of WBRT regimen on OS and PFS. Beside RT modalities, final model variables included age at BM, ECOG, number of brain lesion (1, 2, 3,≥4), Ki67 level, BM chemotherapy, endocrine therapy, target drug use, BM tumor resection status, and meningeal involvement after the extensive screening univariate analyses on others. p<0.05 as ns. BM mean age (range) was 53 (27-82) years old. By the WBRT regiment order above, number (median days of OS vs. PFS) of patients was 51(271 vs. 156 days), 11(271 vs. 144), 13(571 vs. 515) and 30(402 vs. 399) with K-M log-rank test p= 0.11 vs. p=0.04. Compared with none, other WBRT regimen's univariate hazard ratios (HRs) of OS were 1.456 (ns), 0.621 (ns) and 0.658(ns) and their HRs of PFS were 1.321 (ns), 0.581 (ns) and 0.556(p=0.03). On multivariate analyses, their HRs of OS were 1.078 (ns), 0.335(p=0.02), 0.335 (p=0.01) and their HRs of PFS were 0.928 (ns), 0.276 (p=0.003) and 0.288 (p=0.001). WBRT associates independently with improved OS and PFS in setting of modern local and systemic treatments for BM patients from BC. WBRT ≥30 Gy is adequate for both extended survivals.

A Bayesian network meta-analysis of whole brain radiotherapy and stereotactic radiotherapy for brain metastasis.

This study was conducted to compare the effects of whole brain radiotherapy (WBRT) and stereotactic radiotherapy (SRS) in treatment of brain metastasis.A systematical retrieval in PubMed and Embase databases was performed for relative literatures on the effects of WBRT and SRS in treatment of brain metastasis. A Bayesian network meta-analysis was performed by using the ADDIS software. The effect sizes included odds ratio (OR) and 95% confidence interval (CI). A random effects model was used for the pooled analysis for all the outcome measures, including 1-year distant control rate, 1-year local control rate, 1-year survival rate, and complication. The consistency was tested by using node-splitting analysis and inconsistency standard deviation. The convergence was estimated according to the Brooks–Gelman–Rubin method.A total of 12 literatures were included in this meta-analysis. WBRT + SRS showed higher 1-year distant control rate than SRS. WBRT + SRS was better for the 1-year local control rate than WBRT. SRS and WBRT + SRS had higher 1-year survival rate than the WBRT. In addition, there was no difference in complication among the three therapies.Comprehensively, WBRT + SRS might be the choice of treatment for brain metastasis.

Comparison of WBRT alone, SRS alone, and their combination in the treatment of one or more brain metastases: Review and meta-analysis.

Whole brain radiotherapy has been a standard treatment of brain metastases. Stereotactic radiosurgery provides more focal and aggressive radiation and normal tissue sparing but worse local and distant control. This meta-analysis was performed to assess and compare the effectiveness of whole brain radiotherapy alone, stereotactic radiosurgery alone, and their combination in the treatment of brain metastases based on randomized controlled trial studies. Electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) were searched to identify randomized controlled trial studies that compared treatment outcome of whole brain radiotherapy and stereotactic radiosurgery. This meta-analysis was performed using the Review Manager (RevMan) software (version 5.2) that is provided by the Cochrane Collaboration. The data used were hazard ratios with 95% confidence intervals calculated for time-to-event data extracted from survival curves and local tumor control rate curves. Odds ratio with 95% confidence intervals were calculated for dichotomous data, while mean differences with 95% confidence intervals were calculated for continuous data. Fixed-effects or random-effects models were adopted according to heterogeneity. Five studies (n = 763) were included in this meta-analysis meeting the inclusion criteria. All the included studies were randomized controlled trials. The sample size ranged from 27 to 331. In total 202 (26%) patients with whole brain radiotherapy alone, 196 (26%) patients receiving stereotactic radiosurgery alone, and 365 (48%) patients were in whole brain radiotherapy plus stereotactic radiosurgery group. No significant survival benefit was observed for any treatment approach; hazard ratio was 1.19 (95% confidence interval: 0.96-1.43, p = 0.12) based on three randomized controlled trials for whole brain radiotherapy only compared to whole brain radiotherapy plus stereotactic radiosurgery and hazard ratio was 1.03 (95% confidence interval: 0.82-1.29, p = 0.81) for stereotactic radiosurgery only compared to combined approach. Local control was best achieved when whole brain radiotherapy was combined with stereotactic radiosurgery. Hazard ratio 2.05 (95% confidence interval: 1.36-3.09, p = 0.0006) and hazard ratio 1.84 (95% confidence interval: 1.26-2.70, p = 0.002) were obtained from comparing whole brain radiotherapy only and stereotactic radiosurgery only to whole brain radiotherapy + stereotactic radiosurgery, respectively. No difference in adverse events for treatment difference; odds ratio 1.16 (95% confidence interval: 0.77-1.76, p = 0.48) and odds ratio 0.92 (95% confidence interval: 0.59-1.42, p = 71) for whole brain radiotherapy + stereotactic radiosurgery versus whole brain radiotherapy only and whole brain radiotherapy + stereotactic radiosurgery versus stereotactic radiosurgery only, respectively. Adding stereotactic radiosurgery to whole brain radiotherapy provides better local control as compared to whole brain radiotherapy only and stereotactic radiosurgery only with no difference in radiation related toxicities.

Strategies to mitigate the effects of whole-brain radiation therapy on neurocognitive function in patients with brain metastases

Strategies to mitigate the effects of whole-brain radiation therapy on neurocognitive function in patients with brain metastases

Abstract OT1-04-03: Randomized phase II study of induction bevacizumab, etoposide and cisplatin followed by whole brain radiotherapy (WBRT) versus WBRT alone in breast cancer with untreated brain metastases (A-PLUS)

Abstract Background For breast cancer (BC) patients with brain metastases (BM) who are not suitable for surgery/radiosurgery, whole brain radiotherapy (WBRT) remained the only standard treatment. Recently, we have demonstrated that bevacizumab preconditioning followed by etoposide and cisplatin (BEEP) is a highly effective treatment for BM of BC progressing from WBRT (Clin Cancer Res. 2015;21(8):1851). The CNS objective response rate is 77.1% according to volumetric criteria, and 60% according to RECIST 1.1. It has been demonstrated that enlarged brain tumor size is a predictor of WBRT failure. We hypothesized that, for BC with BM, induction BEEP treatment could decrease the size of brain metastases and thereby enhance effectiveness of WBRT. Methods This is a Phase II, randomized, open-labelled study (NCT02185352). Key inclusion criteria: BC with measurable brain metastatic tumor who had not received WBRT and not suitable for surgery or radiosurgery; KPS ≥30%. Key exclusion criteria: patients who had leptomeningeal metastases; history of disease progression during prior cisplatin treatment. In the experimental arm, patients will be treated by induction BEEP for three cycles followed by WBRT. In the control arm, patients will receive upfront WBRT for brain metastases. The BEEP regimen consist of bevacizumab (15 mg/kg) on Day 1 and, with a 1 day window period, followed by etoposide (70 mg/m2/day, Day 2 to Day 4) and cisplatin (70 mg/m2, Day 2), in a 21-day cycle. Stratification is based on the Graded Prognostic Assessment (GPA) score. Primary endpoint: brain-specific progression free survival (PFS) according to RECIST 1.1; key secondary endpoint: the 2-month brain-specific objective response rate (BS-ORR) of BEEP alone and WBRT alone. Other secondary endpoints include overall survival, extra-CNS tumor PFS, safety, time-to-improvement of neurological function,brain-specific PFS according to volumetric criteria, and BS-ORR. Approximately 126 patients will be 2:1 randomized. Multi-center recruitment is ongoing. To our knowledge this is the first randomized trial investigating a targeted therapy plus chemotherapy as induction regimen followed by WBRT as first line treatment for BC with BM. Citation Format: Lu Y-S, Tseng L-M, Yu J-C, Rau K-M, Chao T-Y, Chen S-C, Chiu C-F, Chang Y-C, Chen TW-W, Lin C-H, Chang D-Y, Chao T-C, Huang S-M, Huang C-S, Cheng A-L. Randomized phase II study of induction bevacizumab, etoposide and cisplatin followed by whole brain radiotherapy (WBRT) versus WBRT alone in breast cancer with untreated brain metastases (A-PLUS) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-04-03.

PUB122 Effects of Whole Brain Radiotherapy for Brain Metastases from Lung Adenocarcinoma with or without EGFR Mutations

Our purpose was to analyze the association between WBRT efficacy and EGFR status of BM patients from lung adenocarcinoma. The data of NSCLC were retrospectively reviewed from August 2010 to May 2015, 1391 NSCLC patients with EGFR mutations status referred to Shanxi Cancer Hospital. 304 patients were diagnosed with BM. Among them, 89 patients who received WBRT were eligible for this study. Eighty -nine lung adenocarcinoma patients with BM received WBRT. The standard regimen was 30 Gy in 10 fractions or 40 Gy in 20 fractions. The radiographic response rate (RR) in BM after WBRT, intracranial progression-free survival (IFS) and overall survival (OS) were analyzed. The log-rank test and Cox regression tests were used to confirm the influence of different variables on IPFS and OS. Among all the patients, the total RR was 61.8% (17 with CR and 38 with PR). In uni-variate testing, patients with mutant EGFR had a better RR than those with wild type (86.4% vs 53.7%，P = 0.011). By multivariate analysis, the following were significantly associated with higher radiotherapy RRs : EGFR mutations (OR = 4.262, 95% CI = 1.105-16.435; P = 0.035) and KPS at BM (OR = 8.344, 95% CI =1.688-41.252; P = 0.009). At the end of the 6-month follow-up, there were 63 patients still alive. The median survival time was 12 months (95% CI 9.535-14.465). By the log-rank test, the following were associated with a much longer IPFS: EGFR mutation (P = 0.007), KPS at BM (P<0.001), and control of primary tumor (P = 0.008). Multivariate analysis further revealed that EGFR mutation and KPS scores at BM were independent effectors (Table 3, Figure 1). The univariate analysis revealed that being female (P = 0.066), control of primary tumor (P =0.002), and higher KPS scores (P <0.001) were associated with longer OS. Consistently, by the multivariate analysis, the independent prognostic factors were KPS (P<0.001), and control of primary tumor (P = 0.031). our results suggest that EGFR mutations in BM from lung adenocarcinoma were significantly associated with a better treatment response and a longer IPFS after WBRT, relative to patients without EGFR mutations. However, an influence on OS was not observed. Prospective clinical randomized testing with more patients is needed.

A prospective study of effects of whole brain radiotherapy on cognitive function and quality of life in patients with brain metastases from lung cancer

Objective To evaluate the effects of whole brain radiotherapy (WBRT) on cognitive function and quality of life (QOL) in patients with brain metastases from lung cancer. Methods A total of 41 patients with brain metastases from lung cancer who were admitted to our hospital and treated with WBRT in 2015 were enrolled as subjects. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used for cognitive evaluation. The Alzheimer′s Disease Cooperative Study Activity of Daily Living (ADCS-ADL) scale was used for evaluation of QOL. Comparison of cognitive function and QOL before and after WBRT was made by the independent sample t-test. Results The incidence rates of cognitive dysfunction based on MoCA and MMSE were 96.55% and 48.28% before WBRT, and 94.29% and 31.43% after WBRT, respectively. There were no significant changes in MoCA score, MMSE score, or ADCS-ADL score after WBRT (18.24±0.95 vs. 19.37±0.70, P=0.341; 23.51±0.88 vs. 24.54±0.71, P=0.375; 57.44±2.59 vs. 59.37±2.27, P=0.583). Conclusions WBRT has no significant impacts on cognitive function and QOL in patients with brain metastases from lung cancer. MoCA is more sensitive than MMSE in detection of cognitive dysfunction in patients with brain metastases. Key words: Brain metastases, lung neoplasms/whole brain radiotherapy; Cognitive function; Quality of life; Scale

Renal carcinoma with brain metastases. Prognostic factors and treatment outcomes

Introduction. Surgical excision followed by whole-brain radiotherapy (WBRT) is a traditional treatment option for solitary brain metastases (SBM) of renal carcinoma. In the presence of multiple brain metastases of renal carcinoma WBRT remains to be the most common treatment option in this group of patients. However, the effectiveness of WBRT is insufficient due to radioresistance of renal carcinoma. After introduction of the standards in the radiosurgical practice, treatment options of renal carcinoma have been changed, since radiosurgery may overcome WBRT limitations in the treatment of brain metastases of radioresistant tumors Objective: to study the effectiveness of stereotactic radiosurgery by using “Gamma Knife” device in the treatment of brain metastases of renal carcinoma. Materials and methods. We have analyzed results of the treatment of 112 patients with brain metastases of renal carcinoma who underwent radiosurgical treatment in Moscow Center “Gamma Knife”. Age median of the patients was 58 (33 –77) years. Total number of irradiated metastatic foci – 444, an average number of brain metastases in 1 patient was 4 (1–30). Twenty eight (25.0 %) patients had a single brain metastasis. A median of cumulative volume of brain metastases for each patient was 5.9 (0.1–29.1) cm3. An average value of the marginal dose for metastatic lesion was 22 (12–26) Gy, mean value of isodose used for treatment planning was 64 (39-99) %. Results. An overall survival (OS) rate after radiosurgical treatment was 37.7; 16.4 and 9.3 % for 12, 24 and 36 months, respectively. A me???dian OS was 9.1 months (95% confidence interval (CI) 7.1–11.8). New brain metastases (distant recurrences) following radiosurgical treatment occurred in 44 (54.3 %) patients, with a median of 10.1 months (95 % CI:7-18). Local recurrences after radiosurgical treatment were detected in 19 (17 %) patients with a median time of 6.6 months (95 % CI 4.0–9.6). Factors associated with the best OS: Karnofsky score ≥ 80 (p <0.0369), and the total volume of brain metastases ≤ 5 cm3 (p = 0.0131). Local control was achieved in 96 % of metastatic lesions in 87 % patients. Side effects of radiosurgical treatment occurred in 33.8 % of patients (6% of cases – radionecrosis, 23.8 % – increase in perifocal edema). Conclusion. Radiosurgical treatment alone by using “Gamma Knife” device is an effective treatment option of brain metastases of renal carcinoma, providing a high level of local control of metastatic foci with minimal neurotoxicity. In case of distant recurrence, repeated use of radiosurgery provides a good local control and increase in OS compared with other treatment options.

Whole-brain radiation therapy for brain metastases: detrimental or beneficial?

Stereotactic radiosurgery is frequently used, either alone or together with whole-brain radiation therapy to treat brain metastases from solid tumors. Certain experts and radiation oncology groups have proposed replacing whole-brain radiation therapy with stereotactic radiosurgery alone for the management of brain metastases. Although randomized trials have favored adding whole-brain radiation therapy to stereotactic radiosurgery for most end points, a recent meta-analysis demonstrated a survival disadvantage for patients treated with whole-brain radiation therapy and stereotactic radiosurgery compared with patients treated with stereotactic radiosurgery alone. However the apparent detrimental effect of adding whole-brain radiation therapy to stereotactic radiosurgery reported in this meta-analysis may be the result of inhomogeneous distribution of the patients with respect to tumor histologies, molecular histologic subtypes, and extracranial tumor stages between the groups rather than a real effect. Unfortunately, soon after this meta-analysis was published, even as an abstract, use of whole-brain radiation therapy in managing brain metastases has become controversial among radiation oncologists. The American Society of Radiation Oncology recently recommended, in their “Choose Wisely” campaign, against routinely adding whole-brain radiation therapy to stereotactic radiosurgery to treat brain metastases. However, this situation creates conflict for radiation oncologists who believe that there are enough high level of evidence for the effectiveness of whole-brain radiation therapy in the treatment of brain metastases.

The Influences of Whole Brain Radiotherapy on Social Cognition and Association with Hippocampal and Frontal Dosimetry.

The influence of brain radiotherapy on neurocognition is a major concern. Social cognition is a mental process in the meaning of social interaction and the recognition of facial emotion is a domain of social cognition. Thus, we aimed to investigate the early effect of whole brain radiotherapy on facial emotion recognition ability. Thirteen patients with various brain tumors in the study. Beck depression and anxiety inventory and the facial emotion recognition test by using a set of photographs were performed at the beginning and post radiotherapy. The severity of depression (16.40 ± 12.16 vs 04.00 ± 02.38 points) and anxiety (14.47 ± 11.96 vs 04.54 ± 03.30 points) were significantly higher in patients. The only significance according to facial emotion recognition rate between initial phase of patients and healthy controls was identifying neutral facial em otion (p = 0.002). The patients after brain radiotherapy had significantly better rate of recognizing fear facial emotions (p = 0.039). This study is the first that investigated the effects of cranial irradiation on facial emotion recognition ability and compares this ability with healthy controls. Interestingly, in the early phase the patients seem to be improved in fear facial emotion after brain radiotherapy without sparing cognition specific regions as hippocampus and frontal regions.

Effects of Whole-Brain Radiation Therapy on Resting State Connectivity: A Case Study

Effects of Whole-Brain Radiation Therapy on Resting State Connectivity: A Case Study

P08.15 * RELEVANCE OF GAMMA KNIFE RADIOSURGERY ALONE FOR THE TREATMENT OF NON-SMALL CELL LUNG CANCER BRAIN METASTASES

BACKGROUND AND PURPOSE: Stereotactic radiosurgery (SRS) followed by close follow-up is becoming a popular strategy for the management of brain metastases (BM) since cancer patients live longer and late adverse effects of whole brain radiotherapy (WBRT) are increasingly reported. The authors report their experience in consecutively treated patients with limited brain metastases from non-small cell lung cancer (NSCLC), who underwent SRS in isolation followed by a close follow-up. METHODS: This study is the retrospective analysis of prospectively collected data. We included 89 consecutive patients (80 men and 19 women; mean age 59.7 years) with a KPS score of 60 or greater at BM diagnosis, who underwent Gamma Knife SRS for 1-4 metastases, at Lille University Hospital between January 2004 and December 2010. The mean radiation dose was 23.41 Gy (range 18-26 Gy) and the mean tumor volume was 2.47 cm3 (range 0.3-6.7 cm3). After treatment, clinical and radiological (MRI) monitoring was scheduled at 2, 4, 8 and 12 months in the first year and at 4-month intervals thereafter. RESULTS: Overall survival was 70.8% at 1 year and 50% at 2 years. The actuarial local control rate was 91.5% at 1 year and 85.5% at 2 years. Ten of 89 patients experienced a local failure, which required a salvage treatment. The distant brain control rate was 79.2% at 1 year, and 67.1% at 2 years. A total of 25 patients developed new brain metastases, 10 patients were treated with a new radiosurgical procedure, 12 underwent a WBRT while 3 patients developed a leptomeningeal disease. We reported an overall complication rate of 10.1% per patient and 7.8% per treated tumor; all complications were classified grade 1 or 2. CONCLUSION: In patients with limited brain metastases from NSCLC, SRS is an effective treatment associated with high local control rate with low morbidity. When performed in isolation, close follow-up is mandatory and radiosurgery can be renewed as salvage treatment for distant brain progression, limiting the use of WBRT.

Relevance of gamma knife radiosurgery alone for the treatment of non-small cell lung cancer brain metastases

Background and purposeStereotactic radiosurgery (SRS) followed by close follow-up is becoming a popular strategy for the management of brain metastases as cancer patients live longer and late adverse effects of whole brain radiotherapy (WBRT) are increasingly reported. The authors report their experience in consecutively treated patients with limited brain metastases from non-small cell lung cancer (NSCLC), who underwent SRS alone followed by a close follow-up. MethodsThis study is the retrospective analysis of prospectively collected data. We included of 89 consecutive patients (80 men; mean age 59.7 years) with a KPS score of 60 or greater, who underwent Gamma Knife SRS for 1–4 metastases, at Lille University Hospital between January 2004 and December 2010. The mean radiation dose was 23.41Gy (range 18–26Gy) and the mean tumour volume was 2.47cm3 (range 0.3–6.7cm3). After treatment, clinical and radiological (MRI) monitoring was scheduled at 2, 4, 8 and 12 months in the first year and at 4-month intervals thereafter. ResultsOverall survival was 70.8% at 1 year and 50% at 2 years. The actuarial local control rate was 91.5% at 1 year and 85.5% at 2 years. Ten of 89 patients experienced a local failure, which required a salvage treatment. The distant brain control rate was 79.2% at 1 year, and 67.1% at 2 years. A total of 25 patients developed new metastases, 10 patients were treated with a new radiosurgical procedure, 12 patients underwent a WBRT while 3 patients developed a leptomeningeal disease. We reported an overall complication rate of 10.1% per patient and 7.8% per treated tumour; all complications were classified grade 1 or 2. ConclusionIn patients with limited brain metastases from NSCLC, SRS is an effective treatment associated with high local control rate with low morbidity. When performed in isolation, close follow-up is mandatory and radiosurgery can be renewed as salvage treatment for distant brain progression, limiting the use of WBRT.

Radiation Therapy in the Management of Patients With Limited Brain Metastases

Brain metastases are the most common form of intracranial tumor in adults and an increasingly important cause of morbidity and mortality. Rising incidence is attributed to advanced radiographic imaging and prolonged survival due to improvements in cancer therapy (including systemic therapies) that are not as effective in treating intracranial disease. Standard treatment options for brain metastases include resection, whole-brain radiation therapy (WBRT), stereotactic radiosurgery, or a combination of these modalities. Most patients with brain metastases receive some form of radiation therapy during the course of their illness, and for the majority of them, the prognosis is poor and WBRT remains the standard. However, within this very diverse patient population, subgroups exist in which prolonged survival is possible. In recent years, several randomized controlled trials have clearly demonstrated the efficacy of stereotactic radiosurgery in well-selected patients. This, along with an increased recognition of the late neurocognitive effects of WBRT, has led many to question the role of upfront WBRT in patients with limited intracranial metastases. In this review, we summarize the evolving role of radiotherapy in the management of brain metastases and then discuss the issues related to neurotoxicity from radiation and future areas of investigation.

The role of stereotactic radiosurgery for multiple brain metastases in stable systemic disease: a review of the literature

Cancer patients with brain metastases display a median survival of only 1 to 2 months if left untreated. Although whole-brain radiation therapy (WBRT) has lengthened median patient survival, the long-term neurotoxic effects of WBRT have become a deterrent to its use in the context of stable systemic disease. Therefore, it is important to identify patients who might benefit from stereotactic radiosurgery (SRS) in order to delay or avoid WBRT. Here we present a review of the literature to elucidate the role of SRS in patients with multiple brain metastases. MEDLINE search for English-language articles from 1998 to 2012 describing survival or neurocognitive functioning of patients with multiple brain metastases treated with SRS, WBRT, or a combination. SRS monotherapy yields an equivalent survival with low risk of long-term neurotoxicity, but higher rate of recurrence, compared to WBRT or combined radiotherapy. Patients with ≤4 brain metastases or KPS ≥ 80 are expected to survive significantly longer than the onset time of prominent WBRT-induced neurocognitive decline. SRS, administered alone or adjuvant to surgical resection of symptomatic metastases, is preferred for patients with ≤4 brain metastases or KPS ≥ 80 to delay or avoid WBRT. WBRT can then be employed in the event of recurrence. WBRT with or without resection is preferred for patients with ≥5 brain metastases and KPS < 80, due to these patients' shorter survival and increased recurrence risk. SRS boost treatments can then be used in the event of poor tumor response or progression.

EP-1011: Therapeutic effects of whole brain radiotherapy with carboplatin in management of brain metastasis

EP-1011: Therapeutic effects of whole brain radiotherapy with carboplatin in management of brain metastasis

Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases

Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases

Current Treatment Strategies for Brain Metastasis and Complications From Therapeutic Techniques

Each year approximately 170,000 patients are diagnosed with brain metastasis in the United States, making this the most common intracranial tumor in adults. Historically, treatment strategies focused on the use of whole brain radiation therapy (WBRT) for palliation, yielding a median survival time of only 3 to 6 months. The possible effect of WBRT on cognitive function has generated much concern and debate regarding the use of this modality. Thus, the use of WBRT alone, or in conjunction with other treatment modalities should take into account both risks and benefits, to ensure the best patient outcome with regard to disease state and functional status. The advent of technologies permitting local dose-escalation have clearly increased local control rates, and in select patients, even survival, thereby, further intensifying the debate regarding the use of WBRT. Here, we review the use of WBRT, radiosurgery, and resection for the treatment of brain metastases. Further, we will review the use of radiation sensitizers and blood-brain barrier penetrating cytotoxics such as temozolomide. Finally, we will discuss current treatment strategies for possibly maintaining and improving cognitive function for these patients.