WHOLE-BRAIN RADIOTHERAPY IN THE TREATMENT OF METASTATIC BRAIN-TUMORS

Previous prospective and retrospective trials have failed to demonstra te the best treatment approach for patients with brain metastases. As a result, fractionated whole brain radiotherapy (WBRT) has been the ma instay of treatment for several decades. However, with improved surgic al techniques and the advent of radiosurgical procedures to treat sing le and multiple metastases, the continued value of WBRT is in question . This is particularly true in the treatment of a favorable patient su bset where the risks of long-term morbidity need to be addressed. This article reviews the trials of the Radiation Therapy Oncology Group (R TOG) and other select radiotherapy brain metastases trials, and compar es their morbidities and outcomes to surgical and radiosurgical techni ques. It is unfortunate that the inherent selection bias in most retro spective studies makes comparisons difficult. Therefore, to better und erstand the roles of WBRT, surgery, and radiosurgery in the treatment of brain metastases, additional randomized studies need to be conducte d on homogeneous patient groups. (C) 1998 Wiley-Liss, Inc.