Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases

Abstract

None of the RCTs with altered WBRT dose-fractionation schemes as compared to standard (3000 cGy in 10 daily fractions or 2000 cGy in 4 or 5 daily fractions) found a benefit in terms of overall survival, neurologic function, or symptom control.The use of radiosensitizers or chemotherapy in conjunction with WBRT remains experimental.Radiosurgery boost with WBRT may improve local disease control in selected participants as compared to WBRT alone, although survival remains unchanged for participants with multiple brain metastases.This updated review now includes a total of three RCTs examining the use of radiosurgery alone versus WBRT and radiosurgery. The addition of WBRT to radiosurgery improves local and distant brain control but there is no difference in overall survival. Patients treated with radiosurgery alone were found to have better neurocognitive outcomes in one trial as compared to patients treated with WBRT and radiosurgery.The benefit of WBRT as compared to supportive care alone has not been studied in RCTs. It may be that supportive care alone, without WBRT, is appropriate for some participants, particularly those with advanced disease and poor performance status.

Cost‐effectiveness analysis of neurocognitive‐sparing treatments for brain metastases

“…5,6 The model was run for 60 onemonth cycles, because the majority of patients with brain metastases die within 5 years of diagnosis. 3,[7][8][9][10] In addition, we discounted costs and outcomes at 3%. We evaluated the model using microsimulation to enable adjustments to transition probabilities and outcomes based on earlier cycles.…”

Brain metastases

“…Presenting symptoms tend to have a subacute onset over days to weeks, with the most frequently occurring symptoms at presentation being headache (49%), focal weakness (30%), gait ataxia (21%) and seizures (18%). 1 Less-frequent presentations include nausea, speech disturbance, visual disturbance and sensory disturbance. As would be anticipated from the frequency of these presenting symptoms, most metastases are located within the cerebral hemispheres, the cerebellum less frequently (10-15%) and rarely the brain stem (1-3%).…”

“…As would be anticipated from the frequency of these presenting symptoms, most metastases are located within the cerebral hemispheres, the cerebellum less frequently (10-15%) and rarely the brain stem (1-3%). 1 …”

“…10 However, the resulting toxicity is signifi cant and no randomised evidence of either symptomatic or survival benefi t exists in the CT era. 1 Common toxicities of WBRT include fatigue, alopecia, scalp erythema and impaired higher cognitive function. Somnolence syndrome and severe headaches are less frequently seen adverse effects.…”

Immuno-radiotherapy for brain metastases

“…Different outcomes have been shown in multiple studies in patients stratified with different prognostic scoring systems: most of them have some limitations considering primarily age, KPs and number of BM in multiple primary subsytes. The role of genetic signature and other tumor-related features in BM remains unclear [1][2][3][4].…”