Whole brain radiotherapy for the treatment of multiple brain metastases

Defining treatment for brain metastases patients: nihilism versus optimism

“…Furthermore, from a pragmatic standpoint, whether or not patients died from brain metastases or EC disease does not minimize the important finding that certain groups seem to benefit more from WBRT than others. Consequently, we are less likely to view controlled extracranial disease as a filter preventing consideration of aggressive or WBRT approaches [13][14][15][16].…”

Defining treatment for brain metastases patients: nihilism versus optimism

“…Furthermore, from a pragmatic standpoint, whether or not patients died from brain metastases or EC disease does not minimize the important finding that certain groups seem to benefit more from WBRT than others. Consequently, we are less likely to view controlled extracranial disease as a filter preventing consideration of aggressive or WBRT approaches [13][14][15][16].…”

Stereotactic Radiosurgical Treatment of Brain Metastases to the Choroid Plexus

“…We report the first large, consecutive series of patients with CPMs in whom SRS was used as the sole or principal therapeutic modality. For several decades, standard treatment of most patients with brain metastasis has been WBRT, alone or, in selected patients, after surgical resection (3,22,(25)(26)(27)(28)(29). Although these modalities have provided symptomatic relief, survival after treatment was 4-12 months on average and in that minority with prolonged survival, cognitive, and behavioral decline was not uncommon.…”

“…Although these modalities have provided symptomatic relief, survival after treatment was 4-12 months on average and in that minority with prolonged survival, cognitive, and behavioral decline was not uncommon. Although surgery, performed in selected patients, may improve survival, the two prospective trials to demonstrate an advantage for surgery with WBRT compared to WBRT alone did not address the difficulties of treating patients with more than one lesion or lesions in eloquent or less accessible areas of the brain, including the ventricular system (3,22,(25)(26)(27)(28)(29).…”

“…[43][44][45][46]. Similarly, patients with lesions deep in the brain, in eloquent areas, or with multiple tumors are frequently excluded as candidates for surgery because of the potential for injury of normal, intervening neural structures, which may sometimes lead physicians to prefer WBRT over SRS as well (2,3,(27)(28)(29). Most surgical approaches to the lateral and third ventricles require either a transcortical or transcallosal approach and lesions in the fourth ventricle often require splitting the cerebellar vermis, which may increase operative morbidity (2,10).…”

Cisplatin, fotemustine and whole-brain radiotherapy in non-small cell lung cancer patients with asymptomatic brain metastases: A multicenter phase II study of the Gruppo Oncologico Italia Meridionale (GOIM 2603)

“…Subjects with multiple BMs (generally defined as more than four lesions) do not benefit from surgical resection. In these cases the optimal therapy is to deliver WBRT, with the most commonly used schedule being 30 Gy in 10 daily fractions [4]. With this therapy, up to 50% of cases achieve an improvement in neurologic symptoms and 50-70% of patients have a RR [19][20][21].…”

Defining treatment for brain metastases patients: nihilism versus optimism

“…Furthermore, from a pragmatic standpoint, whether or not patients died from brain metastases or EC disease does not minimize the important finding that certain groups seem to benefit more from WBRT than others. Consequently, we are less likely to view controlled extracranial disease as a filter preventing consideration of aggressive or WBRT approaches [13][14][15][16].…”

Stereotactic Radiosurgical Treatment of Brain Metastases to the Choroid Plexus

“…We report the first large, consecutive series of patients with CPMs in whom SRS was used as the sole or principal therapeutic modality. For several decades, standard treatment of most patients with brain metastasis has been WBRT, alone or, in selected patients, after surgical resection (3,22,(25)(26)(27)(28)(29). Although these modalities have provided symptomatic relief, survival after treatment was 4-12 months on average and in that minority with prolonged survival, cognitive, and behavioral decline was not uncommon.…”

“…Although these modalities have provided symptomatic relief, survival after treatment was 4-12 months on average and in that minority with prolonged survival, cognitive, and behavioral decline was not uncommon. Although surgery, performed in selected patients, may improve survival, the two prospective trials to demonstrate an advantage for surgery with WBRT compared to WBRT alone did not address the difficulties of treating patients with more than one lesion or lesions in eloquent or less accessible areas of the brain, including the ventricular system (3,22,(25)(26)(27)(28)(29).…”

“…[43][44][45][46]. Similarly, patients with lesions deep in the brain, in eloquent areas, or with multiple tumors are frequently excluded as candidates for surgery because of the potential for injury of normal, intervening neural structures, which may sometimes lead physicians to prefer WBRT over SRS as well (2,3,(27)(28)(29). Most surgical approaches to the lateral and third ventricles require either a transcortical or transcallosal approach and lesions in the fourth ventricle often require splitting the cerebellar vermis, which may increase operative morbidity (2,10).…”

Cisplatin, fotemustine and whole-brain radiotherapy in non-small cell lung cancer patients with asymptomatic brain metastases: A multicenter phase II study of the Gruppo Oncologico Italia Meridionale (GOIM 2603)

“…Subjects with multiple BMs (generally defined as more than four lesions) do not benefit from surgical resection. In these cases the optimal therapy is to deliver WBRT, with the most commonly used schedule being 30 Gy in 10 daily fractions [4]. With this therapy, up to 50% of cases achieve an improvement in neurologic symptoms and 50-70% of patients have a RR [19][20][21].…”

Defining treatment for brain metastases patients: nihilism versus optimism

“…Furthermore, from a pragmatic standpoint, whether or not patients died from brain metastases or EC disease does not minimize the important finding that certain groups seem to benefit more from WBRT than others. Consequently, we are less likely to view controlled extracranial disease as a filter preventing consideration of aggressive or WBRT approaches [13][14][15][16].…”

Stereotactic Radiosurgical Treatment of Brain Metastases to the Choroid Plexus

“…We report the first large, consecutive series of patients with CPMs in whom SRS was used as the sole or principal therapeutic modality. For several decades, standard treatment of most patients with brain metastasis has been WBRT, alone or, in selected patients, after surgical resection (3,22,(25)(26)(27)(28)(29). Although these modalities have provided symptomatic relief, survival after treatment was 4-12 months on average and in that minority with prolonged survival, cognitive, and behavioral decline was not uncommon.…”

“…Although these modalities have provided symptomatic relief, survival after treatment was 4-12 months on average and in that minority with prolonged survival, cognitive, and behavioral decline was not uncommon. Although surgery, performed in selected patients, may improve survival, the two prospective trials to demonstrate an advantage for surgery with WBRT compared to WBRT alone did not address the difficulties of treating patients with more than one lesion or lesions in eloquent or less accessible areas of the brain, including the ventricular system (3,22,(25)(26)(27)(28)(29).…”

“…[43][44][45][46]. Similarly, patients with lesions deep in the brain, in eloquent areas, or with multiple tumors are frequently excluded as candidates for surgery because of the potential for injury of normal, intervening neural structures, which may sometimes lead physicians to prefer WBRT over SRS as well (2,3,(27)(28)(29). Most surgical approaches to the lateral and third ventricles require either a transcortical or transcallosal approach and lesions in the fourth ventricle often require splitting the cerebellar vermis, which may increase operative morbidity (2,10).…”

Cisplatin, fotemustine and whole-brain radiotherapy in non-small cell lung cancer patients with asymptomatic brain metastases: A multicenter phase II study of the Gruppo Oncologico Italia Meridionale (GOIM 2603)

“…Subjects with multiple BMs (generally defined as more than four lesions) do not benefit from surgical resection. In these cases the optimal therapy is to deliver WBRT, with the most commonly used schedule being 30 Gy in 10 daily fractions [4]. With this therapy, up to 50% of cases achieve an improvement in neurologic symptoms and 50-70% of patients have a RR [19][20][21].…”