Stereotactic radiosurgery in patients with extensive brain metastases – supporting evidence and knowledge gaps

Excerpt

In the recently published article in JNO, Nagai et al. reported on a retrospective study of 240 patients (160 with 2–10 brain metastases [BM] and 80 with > 10 BM) who underwent SRS [1]. Approximately 80% of the patients in both groups were non-small cell lung cancer histology with the largest BM measuring < 2 cm. The authors observed a median overall survival (OS) of 18.2 and 19.4 months in the 2–10 and > 10 groups, respectively (p = 0.60). Additionally, no significant differences in progression-free survival (PFS) were observed and the number of BM did not have a significant impact on PFS or OS. The authors concluded that SRS may be an effective treatment in appropriately selected patients with > 10 BM. While this study does have inherent limitations, such as its retrospective single institution design and likely selection bias in the cohort of patients with 10 of more BM, it provides valuable evidence in addressing this commonly encountered clinical scenario. …