Brain metastases: fractionated whole-brain radiotherapy.

Brain metastases are the most common malignant adult intracranial tumors, occurring in approximately 10-30% of cancer patients, and generally lead to a poor prognosis. The incidence has been steadily rising, likely due to longer survival from newer systemic therapies and increased utilization of magnetic resonance imaging. Historically, whole-brain radiotherapy has been a standard of care for the management of patients with brain metastases. However, better understanding of both the acute and long-term toxicities associated with whole-brain radiotherapy has led to a more selective use of whole-brain radiotherapy. Herein we discuss the background and prognostication of brain metastases as well as the role of palliative whole-brain radiotherapy, as monotherapy and adjuvant use after resection or stereotactic radiosurgery. We also review refined whole-brain radiation techniques, potential neuroprotective drugs, and ongoing trials.