Evolving management of newly diagnosed brain metastases: Expanding role of radiosurgery in lieu of whole brain radiation

The use of stereotactic radiosurgery has grown increasingly prevalent in the management of patients with brain metastases. In this perspective we contend that a large number of patients can be offered the alternative of treatment with this modality alone, reserving whole brain radiation for salvage. The relevant data will be presented supporting this approach, with emphasis on the toxicities of whole brain radiation and equivalence of survival outcomes regardless of treatment approach. Patient selection for radiosurgery alone will also be addressed.