The role of radiation therapy in the treatment of brain metastases.

Whole brain irradiation is the most effective means for treating the patient with brain metastases with symptom relief occurring in 70 to 90% of patients. However, 25-50% of patients with brain metastases will die due to eventual failure in the brain and therefore entry of patients into investigative trials is essential for continued progress in the management of this problem. For the patient who is not part of an investigative trial, short courses of radiation of 20 Gy in 1 week or 30 Gy in 2 weeks are generally as effective as more prolonged courses and even shorter courses of treatment could be considered, particularly for the patient with an estimated survival of only 5-6 weeks. The importance of the treatment of brain metastases on the practice of radiation oncology is significant and comparable to other major cancers treated with radiation. It is critical that radiation oncologists can apply this treatment modality in a cost effective manner with careful consideration for the patients' quality of life.