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a greater understanding of the phenotypes and functions of subsets of these cell types, will result in new
cancer immunotherapy strategies for PDAC.

REFERENCES
1. Kurahara H, Shinchi H, Mataki Y, Maemura K, Noma H, et al. Significance of M2-polarized tumor-associated macrophages in pancreatic
cancer. J Surg Res 2011;167:e211-9.
2. Gerdes MJ, Sevinsky CJ, Sood A, Adak S, Bello MO, et al. Highly multiplexed single-cell analysis of formalin-fixed, paraffin-embedded
cancer tissue. Proc Natl Acad Sci U S A 2013;110:11982-7.

6. Stereotactic radiosurgery for brain metastasis: the end of whole brain radiotherapy?

Leonardo Frighetto 1,2

1 Department of Neurosurgery, Radiotherapy and Radiosurgery Unit, Hospital Moinhos de Vento, Porto
Alegre, RS 90035-004, Brazil.
2 Coordinator, Neurosurgery Residency Program, Federal University of South Frontier, Zona Rural, Realeza
85770-000, Brazil.

The objective of this presentation is to evaluate the applications of stereotactic radiosurgery (SRS) alone
or in association with whole brain radiotherapy (WBRT) in the management of metastatic brain disease.
Special attention was given to the influence of these treatment modalities on intracranial progression, local
control, functional preservation, quality of life and survival. WBRT alone or following microsurgery has
been the gold standard treatment of brain metastasis. The limited disease concept of oligometastatic brain
disease, opened space to the use of focal therapies, such as SRS. Furthermore, delaying neurocognitive and
cerebelar deterioration related to WBRT, is a worthwile goal in brain metastasis patients. Moreover, SRS is
more effective in the treatment of tumors considered resistant to WBRT such as melanoma and renal cell
carcinoma. Analysis of the available data, including prospective randomized control trials in which SRS-
alone was compared with WBRT+SRS, for patients with 1-4 brain metastasis, have proved that there was
no significant difference in survival, neurologic death, functional independence and quality of life between
the two treatment modalities. The omission of WBRT significantly increased the intracranial progression in
new sites, requiring frequent monitoring in order to detect new lesions before they became symptomatic.
Level 1 data has also demonstrated better neurocognitive function in patients not submitted to WBRT. The
favorable outcomes demonstrated with SRS, have made possible its application in the focal treatment of
surgical cavities. Therefore, the use of the SRS alone approach for oligometastatic brain disease may allow
the majority of patients to avoid WBRT.

Biography
Leonardo Frighetto is the scientific coordinator of the Stereotactic Radiosurgery Unit at Moinhos de Vento
Hospital and coordinator of the Neurosurgery Residency at the Federal University of the South Frontier,
in Brazil. After finishing a fellowship at the Department of Stereotactic and Functional Neurosurgery at
the University of California Los Angeles, he participated in the development of one of the first Stereotactic
Radiosurgery Units in Brazil. The hospital is accredited by the Joint Commission International and
affiliated to Johns Hopkins Medicine International. He also served as the President of the Brazilian Society
of Radiosurgery from 2012 to 2014.