ABSTRACT
WBRT has been shown to reduce the risk of local and distant recurrences of brain metastases when combined with SRS compared to SRS alone (Aoyama et al., 2006; Chang et al., 2009; Kocher et al., 2011; Sahgal et al., 2015). According to the Cochrane Database of Systematic Review of WBRT+SRS versus SRS alone, WBRT decreased the relative risk of any intracranial disease progression at 1 year by 53% (HR 0.47, 95%CI 0.34-0.66, p < 0.0001), but there was no signi‚cant di‰erence in overall survival (HR 1.11, 95%CI 0.83-1.48, p = 0.47) (Soon et al., 2014). e randomized clinical trials also showed that focal
Contents 16.1 Introduction 245 16.2 Indications for WBRT 246 16.3 Studies of WBRT and SIB 247 16.4 Choosing a Prescription for WBRT and SIB 249 16.5 Simulation 250 16.6 Structure and Target Delineation 251 16.7 Radiotherapy Planning 252 16.8 Treatment Delivery 253 16.9 Toxicity 253 16.10 Controversies 254 16.11 Future Directions 255 Checklist: Key Points for Clinical Practice 255 References 256
treatment was associated with less alopecia, less fatigue, less cognitive impairment, and better quality of life as compared to treatment including WBRT, although the quality of the evidence was judged to be low (Patchell et al., 1998; Aoyama et al., 2006, 2007; Roos et al., 2006; Chang et al., 2009; Kocher et al., 2011; McDu‰ et al., 2013; Soetti et al., 2013).
