Reirradiation with intracranial stereotactic radiotherapy in the management of recurrent brain metastases. State of the art.

Abstract

Brain metastases are the most frequent neoplasms of the central nervous system in adulthood, accounting for 50% of intracranial neoplasms. The primary treatment approach includes surgery, intracranial stereotactic radiotherapy and holocranial radiotherapy. Currently, adjuvant and definitive holocranial radiotherapy consists of irradiation of the entire brain and postoperative and definitive intracranial stereotactic radiotherapy, which allows the administration of a high dose of radiation to the tumor lesion, using advanced planning techniques, in 1 - 5 fractions, significantly reducing the risk of local recurrence. Although indicated in patients with a limited number of brain metastases, it is a modality used in recent years as a rescue measure for patients with this entity, however, there is not enough evidence to support it, which is why the focus of this review is aimed at gathering more information on the clinical benefit, as well as some of the variables that may affect the survival of patients with CNS reirradiation for the control of recurrent brain metastases. In intracranial stereotactic salvage radiotherapy, one of the most feared complications in patients who merit reirradiation is radionecrosis, especially in those lesions that occur at the site of previous treatment, due to the multiple adverse effects that this can generate. Giving support to this treatment modality allows us to justify its application in our professional development center and to contribute to its use in other national and international institutions.