The Role of Surgery, Radiosurgery and Whole Brain Radiation Therapy in the Management of Patients with Metastatic Brain Tumors

Abstract

Brain tumors constitute the most common intracranial tumor. Management of brain metastases has become increasingly complex as patients with brain metastases are living longer and more treatment options develop. The goal of this paper is to review the role of stereotactic radiosurgery (SRS), whole brain radiation therapy (WBRT), and surgery, in isolation and in combination, in the contemporary treatment of brain metastases. Surgery and SRS both offer management options that may help to optimize therapy in selected patients. WBRT is another option but can lead to late toxicity and suboptimal local control in longer term survivors. Improved prognostic indices will be critical for selecting the best therapies. Further prospective trials are necessary to continue to elucidate factors that will help triage patients to the proper brain-directed therapy for their cancer.

18F-FDOPA PET for Differentiating Recurrent or Progressive Brain Metastatic Tumors from Late or Delayed Radiation Injury After Radiation Treatment

“…Finally, a time from radiation completion to PET imaging of less than 6 mo was predictive of progression in the univariate analysis but not in the multivariate analysis. This loss of significance might have been due to the presence of other variables, such as a higher likelihood of RPBM versus LDRI in this time period (7,37). Different radiation therapy modalities (e.g., WBRT, SRS, and SRT) might affect 18 F-FDOPA uptake differently in normal brain tissue.…”

“…Radiation therapy can be administered conventionally (whole-brain radiation therapy [WBRT]) or stereotactically (stereotactic radiosurgery [SRS] or stereotactic radiotherapy [SRT]). Most management strategies include surgical excision or SRS plus WBRT (7). Thus, most patients with cerebral metastases receive primary, adjunct, or salvage radiation therapy during the course of their disease.…”

Multimodal imaging enables early detection and characterization of changes in tumor permeability of brain metastases

“…Common treatments of brain metastases include surgery, whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) [61], as well as chemotherapy [62]. Early detection and quantification of the permeability characteristics of micro-metastases can inform decisions on the choice of treatment.…”

Tek Beyi̇n Metastazli Hastalarda Tüm Beyi̇n Ve Si̇mültane Entegre Boost Radyoterapi̇si̇ / Whole Brain Radiotherapy (Wbrt) With Simultaneous Integrated Boost (Sib) in Patients With Single Brain Metastasis

“…Beyin metastazı tüm kanser olgularında %10-40 oranında görülmekte olup gelişen görüntüleme yöntemleri ile erken tanı olasılığı artmakta ve multidisipliner yaklaşımlar ile daha iyi sağkalım sonuçları elde edilmektedir (1). Beyin metastazlı hastalarda sağkalım yaş, hasta performansı, sistemik hastalığın varlığı ve yaygınlığı, mevcut metastazların sayısı ile ilişkili olmakla birlikte medyan sağkalım 2-15 ay arasında değişmektedir (1,2).…”

“…Beyin metastazlı hastalarda sağkalım yaş, hasta performansı, sistemik hastalığın varlığı ve yaygınlığı, mevcut metastazların sayısı ile ilişkili olmakla birlikte medyan sağkalım 2-15 ay arasında değişmektedir (1,2). En sık metastaz nedeni akciğer (%40-50) ve meme (%20-30) kanseridir ve beyin metastazlı olguların %70-80'inde 1-3 adet metastaz (oligometastaz) mevcuttur (3,4).…”