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Whole-Brain Radiotherapy for Brain Metastases: Evolution or Revolution?
Paul D Brown1, Manmeet S Ahluwalia1, Osaama H Khan1
1Paul D. Brown, Mayo Clinic, Rochester, MN; Manmeet S. Ahluwalia, Cleveland Clinic, Cleveland, OH; Osaama H. Khan and Vinai Gondi, Northwestern University Feinberg School of Medicine, Chicago; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Anthony L. Asher, Carolina Neurosurgery and Spine Associates and Neurosciences Institute, Carolinas HealthCare System, Charlotte, NC; and Jeffrey S. Wefel, University of Texas MD Anderson Cancer Center, Houston, TX.
Whole-brain radiotherapy (WBRT) is a common treatment for brain metastases, but concerns about neurocognitive toxicity and new clinical trial data are prompting a re-evaluation of its use and alternatives.
Area of Science:
- Oncology
- Neurology
- Radiotherapy
Background:
- Brain metastases affect approximately 20% of cancer patients.
- Whole-brain radiotherapy (WBRT) is administered annually to ~200,000 US patients for brain metastases.
- Improved survival with new therapies raises concerns about WBRT's long-term toxicities, particularly neurocognitive deficits.
Purpose of the Study:
- To review the current treatment landscape for brain metastases.
- To outline the roles and toxicities of WBRT.
- To discuss alternative therapeutic strategies.
Main Methods:
- Literature review of clinical trials and treatment guidelines.
- Analysis of WBRT efficacy and toxicity data.
- Comparison of WBRT with emerging alternative therapies.
Main Results:
- WBRT remains a standard treatment but carries significant neurocognitive risks.
- Patient survival is increasing, highlighting the need for less toxic options.
- Alternative therapies show promise in managing brain metastases with potentially reduced toxicity.
Conclusions:
- The management of brain metastases is evolving due to increased survival and WBRT-related toxicities.
- A shift towards personalized treatment strategies, including WBRT alternatives, is warranted.
- Further research is needed to optimize treatment for improved outcomes and quality of life.
