Management of brain metastases

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Cancer Treatment

Background:

• Brain metastases treatment is evolving with improved systemic cancer therapies.
• Whole brain radiation therapy (WBRT) was historically standard but has recognized late toxicities.
• Focal therapies are gaining traction due to concerns about WBRT's long-term side effects.

Purpose of the Study:

• To explore the shift towards focal therapies for brain metastases.
• To evaluate the feasibility and implications of deferring WBRT.
• To discuss the balance between tumor recurrence and treatment toxicity on quality of life.

Main Methods:

• Review of current clinical practices and treatment strategies for brain metastases.
• Discussion of the role of radiosurgery and surgical resection as focal therapies.
• Consideration of deferring WBRT based on tumor burden and patient factors.

Main Results:

• Radiosurgery alone is increasingly used for patients with fewer than 7-10 tumors, deferring WBRT.
• Focal therapies allow for earlier initiation of systemic treatments.
• Postoperative radiosurgery after resection may increase subdural dissemination risk, requiring further study.

Conclusions:

• Deferring WBRT in favor of focal therapies is becoming clinically feasible due to technical advancements.
• The optimal management balances local control with systemic therapy and quality of life considerations.
• Future advancements in systemic therapies are crucial for improving survival by controlling both extracranial and intracranial disease.