Stereotactic Radiosurgery for Treatment of Brain Metastases
Ironically, the incidence of brain metastases has risen as anticancer treatments have improved and patients with advanced, metastatic malignancies live longer. The most common treatment approaches for brain metastases include surgical resection, whole-brain radiation therapy, and stereotactic radiosurgery. Although whole-brain radiation therapy has been the standard treatment approach for patients with multiple brain metastases, stereotactic radiosurgery has become increasingly popular because of its relatively short, convenient, and noninvasive treatment course. In contrast, surgery has generally been reserved for select patients with solitary lesions.
Conformal, high-dose delivery of multiple focused radiation beams as well as the shorter outpatient treatment course have contributed to the use of stereotactic radiosurgery in a variety of clinical scenarios, including as a boost with whole-brain radiation therapy; as definitive treatment alone for patients with a limited number of brain metastases; in the pre- or postoperative setting; and in combination with systemic, targeted, and immune-based therapies.
The authors take a historical look at early stereotactic radiosurgery data, present comparisons of results with surgery vs stereotactic radiosurgery, discuss the trend of transitioning away from whole-brain radiotherapy, and evaluate combinations of stereotactic radiosurgery with systemic regimens. Finally, they cover future directions for the treatment of brain metastases, concluding that “data from ongoing and future studies are needed to define the appropriate use of stereotactic radiosurgery in these settings.”