整脑放疗（WBRT）通常被用来缓解脑转移症状、减少手术切除后局部复发的风险，并提高切除或放射外科手术后远处脑控制的能力。虽然针对整个脑部的微转移可以被认为具有优势，但同时暴露健康的脑组织可能会引起不良事件。减轻WBRT后神经认知退化风险的尝试包括选择性避免海马等措施。除了选择性剂量降低，提高剂量以增加肿瘤控制概率的升剂量，例如同时集成提高，技术上是可行的。虽然针对新诊断的脑转移通常采用放射外科或仅针对可见病变的其他技术的前瞻性放疗，但后续（延迟）救治WBRT可能仍然有必要。此外，黑脑膜瘤的存在或广泛的实质性脑转移可能会促使临床医生提前开处WBRT。版权所有©2023 Elsevier Inc.。保留所有权利。

Whole-brain radiation therapy (WBRT) has commonly been prescribed to palliate symptoms from brain metastases, to reduce the risk of local relapse after surgical resection, and to improve distant brain control after resection or radiosurgery. While targeting micrometastases throughout the brain can be considered advantageous, the simultaneous exposure of healthy brain tissue might cause adverse events. Attempts to mitigate the risk of neurocognitive decline after WBRT include the selective avoidance of the hippocampi, among others. Besides selective dose reduction, dose escalation to boost volumes, for example, simultaneous integrated boost, aiming at increased tumor control probability is technically feasible. While up-front radiotherapy for newly diagnosed brain metastases often employs radiosurgery or other techniques targeting visible lesions only, sequential (delayed) salvage treatment with WBRT might still become necessary. In addition, the presence of leptomeningeal tumors or very widespread parenchymatous brain metastases might prompt clinicians to prescribe early WBRT.Copyright © 2023 Elsevier Inc. All rights reserved.