[The role of whole brain irradiation nowadays: more or less or different?]

In patients with poor performance status (KPS<50), ineligibility for effective systemic treatment and multiple brain metastases (BM) best supportive care is the preferred treatment over whole brain radiotherapy (WBRT). WBRT should be considered for the treatment of non-limited number (>4) brain metastases, depending on the patient's life expectancy, neurological symptoms, size, number and location of brain metastases, indication, type and availability of systemic therapy. In these patients if life expectancy is >4 months without small cell histology and without hippocampal lesions, hippocampal sparing WBRT with or without memantine is recommended. Simultaneous integrated boost for the BM is a logical and supportable concept. Prophylactic cranial irradiation (PCI) is still recommended in small cell lung cancer patients with complete remission. Hippocampal sparing WBRT needs further validation in this indication.