Recent Advances and Applications of Radiation Therapy for Brain Metastases

• Published in: Current oncology reports Vol. 24; no. 3; pp. 335 - 342
• Main Authors: Mathis, Noah J., Wijetunga, N. Ari, Imber, Brandon S., Pike, Luke R. G., Yang, Jonathan T.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2022; Springer Nature B.V
• Subjects: Brain cancer; Brain Neoplasms - secondary; Brain tumors; Cranial Irradiation - adverse effects; Humans; Medicine; Medicine & Public Health; Meninges; Metastases; Metastasis; Neuro-oncology (KS Nevel; Oncology; Patients; Protons; Radiation therapy; Radiosurgery; Section Editor; Solid tumors; Survival; Topical Collection on Neuro-oncology; Toxicity; Treatment Outcome; Stereotactic radiosurgery; Craniospinal irradiation; Brain metastases; Radiation therapy; Whole-brain radiotherapy; Proton craniospinal irradiation
• ISSN: 1523-3790; 1534-6269
• DOI: 10.1007/s11912-022-01209-z

Purpose of Review
Radiation therapy (RT) is a mainstay of treatment for brain metastases from solid tumors. Treatment of these patients is complex and should focus on minimizing symptoms, preserving functional status, and prolonging survival.
Recent Findings
Whole-brain radiotherapy (WBRT) can lead to toxicity, and while it does reduce recurrence in the CNS, this has not been shown to provide a survival benefit. Recent advances focus on reducing the toxicity of WBRT or using more targeted radiation therapy. New paradigms including the use of proton RT for leptomeningeal metastases (LM) and stereotactic radiosurgery (SRS) before craniotomy hold promise in improving treatment efficacy and reducing toxicity.
Summary
Omission or replacement of WBRT is often safe and the use of SRS is expanding to include patients with more lesions and preoperative RT. Proton RT holds promise for LM. Progress is being made in improving patient-centered outcomes and reducing toxicity for patients with brain metastases.