Acute toxicity associated with WBRT is generally mild. Cerebral oedema may be induced or worsened after commencement of radiotherapy and commencing corticosteroids prior to radiotherapy may help to limit any increased oedema. In these patients, corticosteroids should be continued throughout the course of radiotherapy and then the dose decreased as tolerated. Patients with small metastases and no mass effect may not need corticosteroids.r
Although most patients treated with WBRT for brain metastases have a limited survival, the risk for late complications is related to the total radiation dose, fraction size, patient age, extent of disease, and neurologic impairment at presentation.
The incidence of neurocognitive deficits in long-term survivors after WBRT remains to be defined. New approaches to avoid cognitive deficits following WBRT are being investigated.