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Review
. 2020 Feb;12(1):67-83.
doi: 10.5114/jcb.2020.93543. Epub 2020 Feb 28.

The role of brachytherapy in the management of brain metastases: a systematic review

Bhargava Chitti  1 , Sharad Goyal  1 , Jonathan H Sherman  2 , Anthony Caputy  2 , Mehrdad Sarfaraz  1 , Gizem Cifter  1 , Hamid Aghdam  1 , Yuan James Rao  1
Affiliations
Review

The role of brachytherapy in the management of brain metastases: a systematic review

Bhargava Chitti et al. J Contemp Brachytherapy. 2020 Feb.

Abstract

Purpose: Brain metastases have a highly variable prognosis depending on the primary tumor and associated prognostic factors. Standard of care for patients with these tumors includes craniotomy, stereotactic radiosurgery (SRS), or whole brain radiotherapy (WBRT) for patients with brain metastases. Brachytherapy shows great promise as a therapy for brain metastases, but its role has not been sufficiently explored in the current literature.

Material and methods: The PubMed, Cochrane, and Scopus databases were searched using a combination of search terms and synonyms for brachytherapy, brain neoplasms, and brain metastases, for articles published between January 1st, 1990 and January 1st, 2018. Of the 596 articles initially identified, 37 met the inclusion criteria, of which 14 were review articles, while the remaining 23 papers with detailing individual studies were fully analyzed.

Results: Most data focused on 125I and suggested that it offers rates of local control and overall survival comparable to standard of care modalities such as SRS. However, radiation necrosis and regional recurrence were often high with this isotope. Studies using photon radiosurgery modality of brachytherapy have also been completed, resulting superior regional control as compared to SRS, but worse local control and higher rates of radiation necrosis than 125I. More recently, studies using the 131Cs for brachytherapy offered similar local control and survival benefits to 125I, with low rates of radiation necrosis.

Conclusions: For a variety of reasons including absence of physician expertise in brachytherapy, lack of published data on treatment outcomes, and rates of radiation necrosis, brachytherapy is not presently a part of standard paradigm for brain metastases. However, our review indicates brachytherapy as a modality that offers excellent local control and quality of life, and suggested that its use should be further studied.

Keywords: brachytherapy; brain metastases; radiation therapy.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Consort diagram for patient eligibility, per PRISMA [14]
See this image and copyright information in PMC

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