Radiosurgical Management of Brainstem Metastasis

Abstract

Brainstem metastases account only for 3% to 5% of all intracranial metastasis. However, brainstem metastases undoubtedly represent a significant source of severe morbidity and mortality in affected patients with estimated average survival duration of only less than 6 months. Surgical resection is not suitable for most brainstem metastases due to the vital architectural structure of the brainstem. What’s more, most conventional chemotherapeutics and targeted agents are ineffective on account of their low blood-brain-barrier penetration capacities. Accordingly, palliative short-course whole-brain radiotherapy stays to be the present standard of care for brainstem metastases. Nonetheless, the limited efficacy of WBRT and related neurocognitive toxicity concerns prompted eagerness on the utilization of stereotactic radiosurgery for brainstem metastases in like manner the cerebral and cerebellar metastases. In a shortage of reliable large series outcomes, the present review article meant to succinctly summarize the current stereotactic radiosurgery evidence on brainstem metastases with an explicit accentuation on the feasibility and efficacy of this novel sophisticated radiotherapy technique in such patients’ groups of bleak prognoses.