Radiotherapy and radiosurgical management of brain metastases

Out of the various cancer treatment modalities available, radiotherapy is the most commonly used for managing metastatic disease in the brain. Until recent years, this was almost exclusively limited to whole-brain radiotherapy (WBRT). Radiosurgery has emerged as a powerful technique for controlling small to moderate-sized brain metastases (<4 cm in diameter). Tumor control rates with radiosurgery are superior to those with WBRT and appear to equal or surpass those with surgery plus WBRT in most studies. The choice among various radiation management strategies (radiosurgery alone, radiosurgery plus WBRT, or surgery followed by radiotherapy) should be based on the size and location of the brain metastases, the functional and neurologic status of the patient, the type of tumor, the tumor imaging characteristics, and the patient’s concerns about the risks and side effects of the proposed treatment.