Over the last decade the use of whole-brain radiotherapy has decreased due to therapeutic advances, as well as in systemic treatment as in radiotherapy, but also due to a growing concern about neurocognitive failure in long-term survivors.

In patients with good prognostic factors (defined by recursive partitioning analysis or disease specific-graded prognostic assessment) and with limited brain metastases (excluding histologies s.a. SCLC, germ cell tumours, lymphomas and leukaemias), there is a trend to defer WBRT and only perform localised treatment (surgery, radiosurgery, stereotactic fractionated radiotherapy) with close follow up.

WBRT is still an option in better prognostic patients with higher intracranial tumour burden. When patients have a poor performance status, best supportive care is an equally valid option.

(BELG J MED ONCOL 2018:12(3):103–109)