Post-operative Treatment for Brain Metastasis

With the advancement of systemic therapies leading to an increase in survival, and the improvement in imaging’s ability to detect smaller lesions, the incidence of brain metastases is rising. Although there is a growing role for systemic therapies, surgery and radiation remain the primary tools in the treatment of brain metastases. In the post-operative setting, radiotherapy can be administered to the whole brain or to the surgical cavity. This addition of adjuvant radiation to the surgical cavity, whether by whole brain radiotherapy (WBRT) or radiosurgery, has been shown to improve local control. However, both adjuvant treatments have been associated with very different side effect profiles. WBRT has been associated with global neurotoxicity, while stereotactic radiosurgery (SRS) is associated with a risk of local radionecrosis. Decisions regarding adjuvant treatment thus have important consequences.