Details

Autor(en) / Beteiligte

• Iorio-Morin, Christian
• Masson-Côté, Laurence
• Mathieu, David
• Ramakrishna, Rohan
• Knisely, Jonathan P.S.
• Magge, Rajiv S.
• Baaj, Ali A.

Titel

Salvage Irradiation for Patients with Recurrent Brain Metastases

Ist Teil von

• Central Nervous System Metastases, p.371-378

Ort / Verlag

Cham: Springer International Publishing

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Brain metastases (BMs) are the most common tumors of the central nervous system. While historically considered a terminal event in a cancer patient’s evolution, BMs are now routinely treated and followed with serial imaging. The management of progressive or recurrent BM after treatment is challenging. Salvage irradiation of a previously irradiated cerebrum is now a well-described strategy available to patients in whom aggressive care is desired. Multiple paradigms have been studied, including SRS after SRS, SRS after WBRT, WBRT after SRS, and WBRT after WBRT. All have been shown to be feasible and safe in properly selected patients. The choice of salvage strategy depends on the initially chosen management modalities. For patients with a good functional status and limited intracranial disease, multiple courses of SRS, irrespective of the previous WBRT, are likely to provide the best results, sparing cognitive functions and maximizing local control. WBRT remains an option for patients with disseminated intracranial disease unresponsive to systemic therapies, or with poor performance status who require palliative symptom control not achievable by best supportive care alone with steroids. In the end, patient survival still mostly depends on the control of primary cancer. As such, when selecting the best management plan for BM, clinicians should consider not only optimal local control but also target quality of life and symptoms control—issues poorly assessed in current studies.