Ameer L Elaimy, John J Demakas, Alexander R Mackay, Wayne T Lamoreaux, Robert K Fairbanks, Barton S Cooke and Christopher M Lee
Brain metastases are the most frequently observed cancerous lesions in the brain and their incidence has grown as advances in imaging technologies and the treatment of extracranial disease has allowed the life expectancy of cancer patients to increase. For this reason, determining optimal treatment regimens for specific subsets of patients with brain metastases is imperative for clinicians. The purpose of this article is to review the randomized controlled trials analyzing patients with brain metastases treated with neurosurgery, WBRT, and SRS to determine future research directions for physicians and scientists. For patients who have a Karnofsky Performance Status (KPS) ≥70 and a single, surgically accessible brain metastasis, surgical resection followed by post-operative WBRT has proven to be a superior treatment modality when compared to WBRT alone and surgical resection alone. Evidence suggests that the addition of WBRT to SRS results in increased levels of survival for patients who have a single brain metastasis and increased levels of local tumor control for patients who have 1 to 4 brain metastases. Questions remain regarding survival and tumor control in patients treated with SRS with or without WBRT, which warrants further clinical investigation into this controversial matter. Although several randomized controlled trials have been published assessing the clinical outcomes of patients with brain metastases treated with a variety of treatment modalities, many studies are limited by poor patient accrual and further randomized evidence is needed to guide clinicians in their future treatment decisions.
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