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Either or Both as the Optimal Treatment

Jeffrey Raizer, MD

JAMA. 2006;295:2535-2536.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Brain metastases are the most feared and debilitating complication of systemic cancers. They affect approximately 170 000 patients a year, with the most common primary tumors being lung cancer, breast cancer, and melanoma.¹ The traditional approach for patients with brain metastases has been whole-brain radiation therapy (WBRT), irrespective of lesion number or primary site.

A shift in treatment occurred for patients with a single brain metastasis after 3 randomized trials were completed.^2-4 In these trials patients were randomized to receive WBRT alone or surgical resection of a single brain metastasis followed by WBRT. In studies by Patchell et al² and Noordijk et al,³ resection of a single brain metastasis prior to WBRT led to an increase in median survival of 25 and 17 weeks, respectively. There was also a significant increase in functionality for the surgical group in both studies. A study by Mintz et al⁴ did not . . . [Full Text of this Article]

Author Affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Ill.

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