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Hippocampal-Avoidance Whole-Brain Radiation Therapy: A New Standard for Patients With Brain Metastases?
Author(s) -
John H. Suh
Publication year - 2014
Publication title -
journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 10.482
H-Index - 548
eISSN - 1527-7755
pISSN - 0732-183X
DOI - 10.1200/jco.2014.58.4367
Subject(s) - medicine , neurocognitive , conventional pci , quality of life (healthcare) , whole brain radiotherapy , radiation therapy , oncology , neurosurgery , radiosurgery , brain metastasis , cancer , surgery , cognition , metastasis , nursing , psychiatry , myocardial infarction
The use of whole-brain radiation therapy (WBRT) for brain metastases was first described in the 1950s.1 Since that time, WBRT has long been considered the treatment of choice, given its wide availability, ease of delivery, and effectiveness in providing palliation for many patients. Numerous phase III trials have also validated its benefit in improving neurologic signs and symptoms for many patients, with median survival times ranging from 3 to 6 months.2–5 Because of the poor outcomes for most patients with brain metastases, some physicians developed a nihilistic view of brain metastases and considered the routine use of WBRT as an obvious approach, given the limited treatment options. As a result, the potential toxicities resulting from WBRT were largely dismissed. However, with the many advances in neurosurgery, imaging, medical oncology, and radiation oncology, the outcomes for some patients have greatly improved, particularly for those with favorable prognostic factors.6,7 With this improvement in outcomes and the higher expectations of patients and physicians, the routine use of WBRT has been highly scrutinized, considering its potential impact on neurocognitive function (NCF) and quality of life (QOL). As a result, the optimal management of brain metastases remains one of the most controversial areas of oncology, even among experts.8,9

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