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Radiation Therapy for Brain Metastases: A Systematic Review
Adam Garsa1, Julie K Jang1, Sangita Baxi2
1Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Practical Radiation Oncology
|June 13, 2021
Summary
Evidence on radiation therapy for brain metastases is limited. Whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) showed no significant survival differences, but more data on quality of life is needed.
Area of Science:
- Oncology
- Radiation Oncology
- Clinical Evidence Synthesis
Background:
- Brain metastases are a common complication of cancer.
- Radiation therapy, including whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS), is a primary treatment modality.
- Synthesizing current evidence is crucial for optimizing patient care.
Purpose of the Study:
- To synthesize available evidence on the comparative effectiveness of radiation therapy for brain metastases.
- To evaluate treatments including WBRT and SRS, alone or in combination, as initial or postoperative therapy.
Main Methods:
- Comprehensive literature search of multiple databases and clinical trials registries up to July 2020.
- Inclusion of randomized controlled trials (RCTs) and large observational studies for safety.
- Analysis focused on brain metastases from lung cancer, breast cancer, or melanoma.
Main Results:
- Limited comparative effectiveness data due to varied interventions and insufficient outcome reporting.
- No significant difference in overall survival or death from brain metastases between SRS plus WBRT versus SRS or WBRT alone.
- Radiation therapy post-surgery did not improve overall survival compared to surgery alone.
Conclusions:
- Despite extensive research, comparative data on radiation therapy for brain metastases remains limited.
- More research is needed on patient-relevant outcomes like quality of life, functional status, and cognitive effects.
- Current evidence does not support systematic differences in adverse events across WBRT and SRS interventions, except for increased vomiting risk with WBRT plus systemic therapy.
