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Indications for Whole-Brain Radiation Therapy

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Radiotherapy in Managing Brain Metastases

Abstract

Whole-brain radiation therapy (WBRT) is a commonly-used treatment in the management of brain metastases, with an established role in symptom palliation and improving overall survival in many, but not all patients. Its role has evolved over time due to advancements in radiosurgical techniques and systemic treatments, and subsequent evidence supporting their use. Patient selection is key, with evidence-based criteria available to guide decision-making. In general, patients who have poor performance status and are older have reduced benefit or even detriment from WBRT, though decisions to omit WBRT should always be made on a case-by-case basis. Strong evidence exists to support the omission of WBRT in favor of radiosurgery in the setting of 1–3 brain metastases, in patients of suitable performance status and overall disease burden. Evidence is emerging to suggest radiosurgery as an alternative to WBRT in patients with 4–15 metastases, though the results of randomized trials are awaited. Newer systemic therapies such as targeted therapy and immunotherapy have demonstrated relatively high rates of intracranial response for patients with limited intracranial disease, though the optimal sequencing and timing of these in combination with radiotherapy is yet to be determined.

WBRT continues to have a role in the palliation of symptomatic leptomeningeal disease, and reirradiation of select patients who progress despite previous WBRT or radiosurgery. It has an established role in the management of small-cell lung cancer, with high-quality evidence supporting its use as prophylactic cranial irradiation. The use of hippocampal-avoidance WBRT is supported by recent evidence demonstrating improvements in neurocognitive toxicity compared with standard WBRT.

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Author information

Authors and Affiliations

  1. Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Michael Huo

  2. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Michael Huo

  3. School of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Michael Huo, Matthew Foote & Mark B. Pinkham

  4. Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queens University, Kingston, ON, Canada

    Fabio Ynoe de Moraes

  5. School of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Matthew Foote & Mark B. Pinkham

  6. Department of Radiation Oncology, Hospital Sírio-Libanês and Instituto do Câncer de Estado de São Paulo (ICESP) – Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil

    Gustavo N. Marta

  7. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    John H. Suh

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  1. Michael Huo
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  6. John H. Suh
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Editors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Yoshiya Yamada

  2. Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA

    Eric Chang

  3. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    John B. Fiveash

  4. Weill Cornell Medicine, NewYork–Presbyterian Hospital, New York, NY, USA

    Jonathan Knisely

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Huo, M., de Moraes, F.Y., Foote, M., Pinkham, M.B., Marta, G.N., Suh, J.H. (2020). Indications for Whole-Brain Radiation Therapy. In: Yamada, Y., Chang, E., Fiveash, J., Knisely, J. (eds) Radiotherapy in Managing Brain Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-43740-4_12

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