Halloran E Peterson, Erik W Larson, Robert K Fairbanks, Wayne T Lamoreaux, Alexander R MacKay, Jason A Cal, John J Demakas, Barton S Cooke and Christopher M Lee
Metastases are the most common neoplasm of the brain. When these occur in the brainstem, prognosis is poor and treatment options are limited. However, stereotactic radiosurgery has been investigated as a management tool for brainstem metastases. The aim of this review is to gather and summarize data related to the safety and efficacy of stereotactic radiosurgery for the treatment of brainstem metastases. To identify trials for inclusion in this review, a PubMed search using the keywords “stereotactic radiosurgery” and “brainstem metastases” was performed. With this method, we selected 21 series published between 1999 and 2014. Median survival times for these studies averaged 8.3 months (range: 3-16.8 months). Control of systemic disease and performance status were identified as important predictors of survival time. Adjuvant whole-brain radiation therapy was not shown to increase survival. The studies reviewed here report adverse radiation effects at an average rate of 6.7% (range: 0-27%). Stereotactic radiosurgery provides effective local tumor control and may increase survival time for patients with brainstem metastases. Further study is needed to establish dosage guidelines for maximal benefit as well as to evaluate the efficacy of radiosurgery in symptom management.
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