In many patients with brain metastases, the primary
therapeutic aim is symptom palliation and maintenance of neurologic function,
but in a subgroup, long-term survival is possible. Local control in the brain,
and absent or controlled extracranial sites of disease are prerequisites for
favorable survival.
Stereotactic radiosurgery (SRS) is a focal, highly precise
treatment option with a long track record. Its clinical development and
implementation by several pioneering institutions eventually rendered possible
cooperative group randomized trials. A systematic review of those studies and
other landmark studies was undertaken.
Most clinicians are aware of the
potential benefits of SRS such as a short treatment time, a high probability of
treated-lesion control and, when adhering to typical dose/volume
recommendations, a low normal tissue complication probability.
However, SRS as
sole first-line treatment carries a risk of failure in non-treated brain
regions, which has resulted in controversy around when to add whole-brain
radiotherapy (WBRT). SRS might also be prescribed as salvage treatment in
patients relapsing despite previous SRS and/or WBRT. An optimal balance between
intracranial control and side effects requires continued research efforts.
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