Stereotactic Radiosurgery for the Management of Brain Metastases

A 50-year-old man with a history of lung cancer presents with headaches and right-arm numbness; he is found to have a single brain metastasis. Stereotactic radiosurgery is recommended as part of his care. Stereotactic radiosurgery uses multiple narrowly focused beams of radiation to treat one or a few focal lesions while minimizing effects on the surrounding tissue. A 50-year-old man with a history of lung cancer is found to have a single brain metastasis. Stereotactic radiosurgery is recommended as part of his care. Foreword This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations. Stage A 50-year-old man with a history of locally advanced non–small-cell lung cancer presents with moderately severe headaches and mild numbness of the right arm. He is functionally independent and has no coexisting medical conditions. His neurologic examination is normal except for some diminished sensation in the right arm. Magnetic resonance imaging (MRI) of the brain reveals a single lesion, 2.5 cm in diameter, in the left parietal region, with a moderate amount of edema. Additional testing shows no evidence of extracranial disease. He is treated with dexamethasone, with rapid improvement of his symptoms. His physicians recommend whole-brain radiation therapy . . .