Strategy of surgery and radiation therapy for brain metastases.
Cancer patients with brain metastases have poor prognoses and their median survival time is about 1 year. Surgery with whole-brain radiation therapy (WBRT) has been used in the treatment of single brain metastasis measuring 3 cm or more. Stereotactic radiosurgery (SRS) including the use of the Gamma knife and Cyberknife is widely used for the treatment of small and multiple brain metastases; however, recent clinical studies have revealed that SRS + WBRT is superior to WBRT or SRS alone in terms of survival time and local tumor control rates. Here, surgical indications and the strategy of surgery and radiation therapy are discussed, based on many clinical trials of treatments for brain metastases. To improve the survival rate and quality of life for these cancer patients with brain metastases, it is necessary to choose the most suitable mode of surgery and radiotherapy with the close cooperation of physicians, surgeons, radiologists, and neurosurgeons, based on accumulated evidence.
Narita
Yoshitaka
Y
Neurosurgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan. yonarita@ncc.go.jp
Shibui
Soichiro
S
D000203:Activities of Daily Living; D000927:Anticonvulsants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D016371:Cranial Irradiation / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D007564:Japan; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010348:Patient Care Team; D018579:Patient Selection; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D000927:Anticonvulsants; D000970:Antineoplastic Agents; D013256:Steroids
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