Does Stereotactic Radiosurgery Have a Role in the Management of Patients Presenting with 4 or More Brain Metastases?

Academic Article


  • Stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) are effective treatments formanagement of brain metastases. Prospective trials comparing the 2modalities in patients with fewer than 4 brain metastases demonstrate that overall survival (OS) is similar. Intracranial failure is more common after SRS, while WBRT is associated with neurocognitive decline. As technology has advanced, fewer technical obstacles remain for treating patients with 4 or more brain metastases with SRS, but level I data supporting its use are lacking. Observational prospective studies and retrospective series indicate that in patients with 4 or more brain metastases, performance status, total volume of intracranial disease, histology, and rate of development of new brain metastases predict outcomes more accurately than the number of brainmetastases. It may be reasonable to initially offer SRS to some patients with 4 or more brain metastases. Initiating therapy with SRS avoids the acute and late sequelae of WBRT. Multiple phase III trials of SRS vs WBRT, both currently open or under development, are directly comparing quality of life and OS for patients with 4 or more brain metastases to help answer the question of SRS appropriateness for these patients.
  • Authors

    Published In

  • Neurosurgery  Journal
  • Digital Object Identifier (doi)

    Author List

  • Soike MH; Hughes RT; Farris M; McTyre ER; Cramer CK; Bourland JD; Chan MD
  • Start Page

  • 558
  • End Page

  • 566
  • Volume

  • 84
  • Issue

  • 3