Several randomized studies of surgery/radiosurgery (SRS) plus or minus whole brain radiotherapy (WBRT) have established the following similar conclusions:
1. WBRT has not influenced survival
2. WBRT has decreased the incidence of brain metachronous metastases to other areas of the brain in both surgical and SRS series
3. WBRT has decreased the risk of recurrence at the surgical site
WBRT is associated with increased likelihood of effects on memory and cognition, particularly in older patients, and although is does reduce the risk of recurrent disease in brain, it has no beneficial survival advantage. In addition, salvage treatment with either further SRS or WBRT at subsequent recurrence of brain metastases has been demonstrated to be effective.
In addition, recent data suggests that the results of SRS for patients with 5-10 brain metastases show similar results as in patients with 1-4 metastases, and that in patients with surgical resection of brain metastases, several phase II studies of surgical cavity SRS has been shown to be effective in patients with in non-superficial brain metastases that are < 3 cm in diameter.
As a result, the role of WBRT in patients with a limited number of brain metastases is now a controversial subject, and the current standard of care for patients with newly diagnosed brain metastases is in flux.
This session will review the current evidence of the management of patients with brain metastases and conclude with some guiding principles.