Use your whole brain.

You’ve probably seen this case by now: a well-informed patient with multiple brain mets who fears nothing (including cancer) more than whole brain radiation. Neither whole brain radiation nor stereotactic radiosurgery has proven to confer superior survival for this population. For this reason, it has become necessary to find other reasons why the sexier treatment is “superior.” And that reason has largely been cognitive deficits from whole brain as opposed to focal stereotactic radiation. As this editorial points out, perhaps we have done our patients and ourselves a disservice advancing technology by heightening patients' fears of neurocognitive toxicity. TBL: There are times when whole brain radiation is the best treatment, and those times don’t need to feel like crushing defeats. | Brown, Cancer 2018