[Therapy of CNS metastases]

Brain metastases occur in 20-30% of patients with systemic cancer and represent one of the most unfavourable prognostic parameters. In the majority of cases brain metastases are multiple and are usually treated with whole brain irradiation. The treatment of single brain metastases often includes surgery, followed by whole brain radiotherapy. Although the goal of treatment of both single and brain metastases is almost always palliation and not cure, it is important that several modes of treatment are carefully compared. In comparing different treatment regimens it should be emphasised that not only duration of survival time and time until tumour recurrence are used as outcome parameters but also the quality of life. The only way in which the results of different therapies can be compared is by means of randomised trials. As long as high quality studies are not available, any definitive assessment of the relative effectiveness of radiosurgery to standard treatment for brain cannot be defined. Radiosurgery can be used to treat patients, whose metastases recur after traditional therapies. As with other definitive therapies for patients with brain metastases, highly functional patients with well-controlled systemic cancers derive the greatest benefit from treatment with radiosurgery.