What factors determine if whole brain radiation therapy is recommended to treat metastatic brain tumors?

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CharlesCobbsMD (Physician - Neurosurgery (Verified) ) - 08 / 24 / 2012

There are multiple factors that determine whether or not WBRT is recommended to treat metastatic brain tumors. One of the most critical factors is the status of the patient’s current health and the status of the patient’s primary cancer at the time of the diagnosis. For instance, if a patient has widely metastatic breast cancer and has multiple brain metastases and is thought to have only a couple of months life expectancy, then surgery or stereotactic radiation treatment for multiple brain metastases would be not considered appropriate. In this case whole brain radiation treatment would probably be the recommended therapy. However, as mentioned above, if the patient seems to be doing very well with respect to their primary cancer or has no evidence of significant disease with their primary cancer and they only have one or 2 or 3 metastatic brain tumors, then this patient would be much more likely to get either surgical resection or stereotactic radiosurgery instead of WBRT. Even in cases of surgical resection of one or more metastatic brain tumors, and/or stereotactic radiation therapy of metastatic brain tumors, WBRT is often used as an adjuvant treatment. The current medical literature is somewhat controversial when it comes to the risks vs. benefits of adding WBRT on top of surgery or stereotactic radiation therapy. While WBRT can decrease the occurrence of future brain metastases in many cases, the side effects of WBRT may outweigh the benefits of preventing future potential metastases. This debate continues amongst radiation oncologists.
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