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].…”

“…There are now four main prognostic indices for brain metastases patients that assist decision making on what to offer these patients [7,[12][13][14] ( Table 1). The two most rigorously developed are from the Radiation Therapy Oncology Group (RTOG) database of clinical trials, with the recursive partitioning analysis (RPA) model having been the gold standard for more than a decade and the graded prognostic assessment (GPA) a recent refinement from this [12].…”

Radiothérapie en conditions stéréotaxiques des métastases cérébrales

“…Les doses devront tenir compte des doses déjà délivrées aux organes à risque (tronc cérébral, voies optiques, moelle épinière, cochlée) [25]. Cependant, le cumul de dose équivalente est difficile à effectuer du fait de l'absence de données claires pour transformer les doses de radiochirurgie ou radiothérapie hypofractionnée en conditions stéréotaxiques en « équivalent radiobiologique 2 Gy ».…”

“…Les mêmes principes que ceux liées aux procédures sans chirurgie doivent être utilisés [25,26]. Le volume cible correspond alors à la cavité opératoire et à sa prise de contraste périphérique, mais n'inclut ni l'oedème éventuel, ni le trajet de la voie d'abord [27].…”

Modern management of rare brain metastases in adults

“…Controlled trials demonstrate an increase in the duration of functionally independent survival in patients with single BM undergoing surgery and WBRT versus WBRT alone. There is also a trend towards reducing the number of deaths due to neurological causes, although overall survival rates are not significantly affected [9,10]. On the other hand, irradiation is a risk factor for development of benign and malignant tumors [11,12]; with advancing prolonged survival rates, this could pose a future problem, particularly in children but also in adults [13].…”