Is there a role for whole-brain radiation therapy in the treatment of brain metastases?—Limited.
An estimated 400 000 patients with cancer will develop brain metastases (BrM) this year, and more than half will undergo whole-brain radiation therapy (WBRT). Multiple phase 3 trials have provided level 1 evidence to support the use of single-fraction stereotactic radiosurgery (SRS) alone in patients with 1 to 3 BrM because WBRT has no survival benefit and is associated with impaired cognitive function and quality of life (QOL). There is also emerging evidence to support that SRS may be the appropriate treatment for patients with 4 or more BrM as well. With recent advancement in systemic therapy with central nervous system penetration, the role of WBRT has been further diminished in the management of patients with BrM.
Li J, Brown PD. The Diminishing Role of Whole-Brain Radiation Therapy in the Treatment of Brain Metastases. JAMA Oncol. Published online January 05, 2017. doi:10.1001/jamaoncol.2016.5411