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Combined role of whole-brain radiation therapy and radiosurgery for the treatment of brain metastasis.

While the optimal treatment of brain metastases remains controversial, there is a clear role for radiotherapy in the management of this disease. Herein, we discuss, based upon the prospective randomized trials, the interplay of surgical resection, whole-brain radiation therapy and stereotactic radiosurgery. Specific treatment recommendations depend on various clinical parameters and patient preference. Consistently, multiple trials of whole-brain radiation therapy have demonstrated improved local control, decreased progression elsewhere in the brain, but no overall survival benefit and concern for worse neurocognitive outcome. However, both new medications and technological advancements in the delivery of radiation therapy aim to reduce the neurocognitive sequelae of whole-brain radiation therapy. Stereotactic radiosurgery has been demonstrated to improve overall survival in patients with a single brain metastasis when delivered in conjunction with whole-brain radiation therapy. Unfortunately, there is no current role to the addition of chemotherapy to radiation therapy for brain metastases.