title: Long-term management of patients with multiple brain metastases after shaped beam radiosurgery. Case report and review of the literature.
abstract: The role of radiosurgery in the treatment of patients with advanced-stage metastatic disease is currently under debate. Previous randomized studies have not consistently supported the use of radiosurgery to treat patients with numbers of brain metastases. In negative-results studies, however, intracranial tumor control was high but extracranial disease progressed; thus, patient survival was not greatly affected, although neurocognitive function was generally maintained until death. Because the future promises improved systemic (extracranial) therapy, the successful control of brain disease is that much more crucial. Thus, for selected patients with multiple metastases to the brain who remain in good neurological condition, aggressive lesion-targeting radiosurgery should be very useful. Although a major limitation to success of this therapy is the lack of control of extracranial disease in most patients, it is clear that well-designed, aggressive treatment substantially decreases the progression of brain metastases and also improves neurocognitive survival. The authors present the management and a methodology for rational treatment of a patient with breast cancer who has harbored 24 brain metastases during a 3-year period.
authors.affiliation: Department of Radiation Oncology, James P Wilmot Cancer Center at the University of Rochester Medical Center, NY 14642, USA. paul_okunieff@urmc.rochester.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Okunieff
authors.forename: Michael C
authors.initials: MC
authors.lastname: Schell
authors.forename: Russell
authors.initials: R
authors.lastname: Ruo
authors.forename: E Ronald
authors.initials: ER
authors.lastname: Hale
authors.forename: Walter G
authors.initials: WG
authors.lastname: O'Dell
authors.forename: Webster
authors.initials: W
authors.lastname: Pilcher
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011182:Postoperative Care; D016634:Radiosurgery; D013997:Time Factors