Multiple brain mets: GammaKnife alone versus WBRT

[Olga]

I've done some reading on the current information avail. on the strategy of the the treatment for the multiple brain mets - doing Gamma Knife as they appear versus combining it with the WBRT:

1. There is an article re. Gamma Knife treatment being equally effective in setting of the multiple (5-10 versus few (2-4) brain mets:
http://www.ncbi.nlm.nih.gov/pubmed/23839414

2. This is an article from the Gamma Knife Center, Karolinska University Hospital, Stockholm, Sweden and Gamma Knife Centre, Bupa Cromwell Hospital, London, United Kingdom:
Stereotactic radiosurgery in the treatment of brain metastases: The current evidence.
http://www.ncbi.nlm.nih.gov/pubmed/23810288
that shows that WBRT does very little for preventing new brain mets versus simply doing Gamma Knife as they appear:
"New remote brain metastases are reported in 33-42% after WBRT and in 39-52% after radiosurgery " - at first it seems that there is some benefit from WBRT but we have to correct the number by the types of cancers that are very radiosensitive (ASPS is not). They conclude:
"Larger metastases (>8-10cc) should be removed surgically, but for smaller metastases Gamma Knife radiosurgery appears to be equally effective as surgical tumor resection (level I evidence). Radiosurgery avoids the impairments in cognition and quality of life that can be a consequence of WBRT (level I evidence)."

3. There is also a recent study done in a lung cancer setting:
Multiple gamma knife radiosurgery for multiple metachronous brain metastases associated with lung cancer : survival time.
http://www.ncbi.nlm.nih.gov/pubmed/23133721
that shows that multiple GKRS for multiple metachronous brain metastases (they appear with an interval not at once) produces better survival than a single GKRS plus WBRT. They conclude:
"Our result supports that multiple GKRS is of value in extending the survival time in patients with multiple metachronous brain metastases, and that the number of the lesions and the frequency of development of new lesions are not an obstacle in treating patients with GKRS."