American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with multiple brain metastases, the typical treatment method is?

1. Surgical resection

2. Whole-brain radiation therapy

3. Focused radiation therapy

4. Chemotherapy

The correct answer is: Whole-brain radiation therapy

In the management of patients with multiple brain metastases, whole-brain radiation therapy (WBRT) is typically the preferred treatment method. This approach is chosen primarily because it can effectively target multiple areas in the brain simultaneously, addressing the metastatic lesions that arise from various primary tumors. WBRT is particularly valuable for patients who have numerous brain metastases (often defined as more than three), where surgical options would be limited due to the sheer number and distribution of the tumors. Furthermore, whole-brain radiation therapy provides symptomatic relief, helps to prevent further neurological decline, and can improve overall survival in appropriate patients. While surgical resection can be beneficial for solitary or limited brain metastases, and focused radiation therapy could be an option for a few lesions, these methods typically are not suitable for widespread metastases. Chemotherapy generally plays a role in systemic management but is not usually effective for brain metastases alone due to the blood-brain barrier. Therefore, for patients presenting with multiple brain metastases, WBRT serves as a comprehensive treatment strategy that can improve outcomes effectively.