With an incidence of 15/10(5) in the general population, brain metastases constitute a serious, debilitating complication in cancer patients. The majority of those patients suffer from more than one metastasis, but up to 30% to 40% present with a solitary lesion. Whole-brain radiotherapy (WBRT) extends median survival from 1 to 2 months for treatment with steroids only, to 4 to 6 months in most series. However, long-term survival(>l-2 years) is observed in up to 10% of patients with favorable prognostic factors, such as solitary lesions, good Karnofsky performance status, and absence of extracranial disease. For those patients, individually optimized treatment is worthwhile. For good-prognosis patients with controlled extracranial disease, surgery in combination with postoperative WBRT should be considered, especially when fast relief of symptoms is mandated. For surgically inaccessible solitary lesions below a size threshold of approximately 30 ccm, stereotactic radiosurgery (RS), although never compared to surgery in a randomized fashion, seems to yield comparable results and is the treatment of choice for more than one lesion in appropriately selected patients. Nevertheless, a number of questions concerning the optimal treatment regimens for brain metastases remain. These mainly concern the radiation dose, need for a combination of RS and WBRT, relative timing of different treatment modalities, and maximum number of brain metastases that can reasonably be treated with RS when long-term progression-free survival is the peal. However, RS is definitely an excellent option for salvage and palliation in patients with short life expectancy, as it is simultaneously noninvasive and cost-effective, with short hospitalization times. (C) 2001 Wiley-Liss, Inc.
|Data di pubblicazione:||2001|
|Titolo:||Adjuvant treatment of brain metastases|
|Autore/i:||Lohr, F; Pirzkall, A; Hof, H; Fleckenstein, K; Debus, J|
|Digital Object Identifier (DOI):||10.1002/ssu.1016|
|Codice identificativo ISI:||WOS:000167906600007|
|Codice identificativo Scopus:||2-s2.0-0035050254|
|Citazione:||Adjuvant treatment of brain metastases / Lohr, F; Pirzkall, A; Hof, H; Fleckenstein, K; Debus, J. - In: SEMINARS IN SURGICAL ONCOLOGY. - ISSN 8756-0437. - 20:1(2001), pp. 50-56.|
|Tipologia||Articolo su rivista|
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