Whole-brain radiation therapy and stereotactic radiosurgery in patients with brain metastases 

One of the motivation that we conducted randomized comparison between whole brain radiotherapy (WBRT) plus stereotactic radiosurgery (SRS) versus SRS alone was that SRS-alone was regarded as if it was a standard and recommendable treatment in Japan and some other countries back in 1990’s. However, there had not yet been a general consensus regarding the risks and/or benefits of omitting upfront WBRT at that time with level I evidence. We compared 132 patients with 1-4 brain metastases between two treatment methods in this study ¹. Our findings demonstrated that SRS alone without upfront WBRT was associated with increased brain tumor recurrence; however, it did not result in either worsened neurological function or increased risk of neurologic death. Therefore, the omission of WBRT from the initial management of brain metastases can be now justified. However, we should keep in mind that the risk of brain tumor recurrence was significantly higher when WBRT was not included in the initial management, therefore frequent monitoring of brain status should be conducted when patients were treated without WBRT. 

Bibliographical reference: 

1. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G. "Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial", JAMA. 2006 Jun 7; 295 (21): 2483-2491.

Hidefumi Aoyama

Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan