AANS Neurosurgeon | Volume 27, Number 1, 2018

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Radiosurgery vs. Whole-Brain Radiation in Lung Cancer Patients with Multiple Brain Metastases

Although targeted therapies have produced dramatic advances in our ability to control some types of advanced lung cancer, growth of the disease in the brain remains a major problem. Radiation is often used to treat deposits in the brain, but the best technique to deliver radiation can be controversial. Whole-brain radiation therapy, as its name suggest, treats the entire brain but can be associated with notable cognitive side effects. Another strategy, radiosurgery, directs highly-focused radiation only to the sites of metastasis, largely sparing the normal brain.

The challenge has been to define in which circumstances each technique is best. The debate has centered on the number of brain metastases, with the field generally agreeing that with three or fewer deposits, radiosurgery is the preferred approach, and then switching to the use of whole-brain radiation to treat four or more deposits.

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