caa a22 4500 445299061 CHVBK 20180317142551.0 cr unu---uuuuu 170323e20100701xx s 000 0 eng 10.1007/s11940-010-0074-9 doi (NATIONALLICENCE)springer-10.1007/s11940-010-0074-9 Management of Brain Metastases [Elektronische Daten] [John Stewart, Stephen Sawrie, Asim Bag, Xiaosi Han, John Fiveash] Opinion statement: As systemic cancer therapies have improved, the natural history and importance of treating brain metastases continues to evolve. Historically, most patients with brain metastases have been managed with whole brain radiation therapy (WBRT) with surgical resection or radiosurgery added for patients with single or few metastases. Because the potential late toxicity of WBRT is increasingly recognized when systemic tumor is more effectively controlled, there has been increased interest in the use of focal therapies such as radiosurgery with deferred WBRT even for patients with larger numbers of metastases. Although WBRT in combination with radiosurgery or surgical resection significantly reduces central nervous system recurrences at the treated site and elsewhere in the brain, it is not clear whether a patient's quality of life is more affected by tumor recurrence or by treatment with WBRT. In our practice, most patients with fewer than 7 to 10 tumors are treated with radiosurgery alone, with WBRT initially deferred because of concerns about its late toxicity. The ongoing technical improvements in radiosurgery have made this transition away from WBRT clinically feasible. This approach also allows patients to begin systemic therapy sooner, rather than waiting 2 to 4weeks to complete WBRT. For patients with large or very symptomatic tumors, surgical resection is performed, followed by postoperative radiosurgery to the resection cavity, again initially deferring WBRT for many patients. This focal-only approach in the postoperative setting is associated with a higher rate of subdural dissemination and needs further prospective study, as some would argue that tumor progression is the major determinant of loss of function. Ultimately, better survival will require better systemic therapy that both controls extracranial disease and penetrates the brain to reduce intracranial recurrences. Unfortunately, many clinical trials of novel agents exclude patients with brain metastases. Springer Science+Business Media, LLC, 2010 Stewart John University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut Sawrie Stephen University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut Bag Asim University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut Han Xiaosi University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut Fiveash John University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut Current Treatment Options in Neurology Current Science Inc. 12/4(2010-07-01), 334-346 1092-8480 12:4<334 2010 12 11940 https://doi.org/10.1007/s11940-010-0074-9 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11940-010-0074-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Stewart John University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut NATIONALLICENCE 700 1- Sawrie Stephen University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut NATIONALLICENCE 700 1- Bag Asim University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut NATIONALLICENCE 700 1- Han Xiaosi University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut NATIONALLICENCE 700 1- Fiveash John University of Alabama at Birmingham, 619 South 19th Street South, 35249-6832, Birmingham, AL, USA aut NATIONALLICENCE 773 0- Current Treatment Options in Neurology Current Science Inc 12/4(2010-07-01), 334-346 1092-8480 12:4<334 2010 12 11940 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer