From the Neuro-Oncology Center, University of Virginia, Charlottesville, VA (D.S.) and the Division of Neuro-Oncology, Ohio State University, Columbus, OH (R.C.)
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to David Schiff, MD, University of Virginia Neuro-Oncology Center, Box 800432, Charlottesville, VA 22908-0432; e-mail: davidschiff{at}virginia.edu
Overview: Although whole-brain radiotherapy (WBRT) has long been the standard of care for newly diagnosed brain metastases, local strategies including radiation and stereotactic radiosurgery (RS) have proven beneficial in improving long-term local control and, in some cases, survival. The ease and convenience of RS, combined with concerns regarding the neurocognitive and quality-of-life effects of WBRT, has led to widespread use of RS in patients with newly diagnosed brain metastases. Nonetheless, substantial concerns remain in patients treated solely with RS regarding the deleterious effect of development of new brain metastases that WBRT might have prevented. This article reviews recent data on the efficacy and toxicity of WBRT and RS. Results of completed and ongoing randomized clinical trials exploring the relative benefits of WBRT, RS, and their combination are summarized. As economic pressures to constrain health care costs increase, physicians will need to base management of this common clinical situation on data from these and future clinical trials. The incorporation of quality-of-life and neurocognitive measures in these trials is necessary.
