Brain metastases treatment guidelines
ASCO-SNO-ASTRO Guideline 2022
EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours 2021
https://www.annalsofoncology.org/article/S0923-7534(21)02214-6/fulltext Published:August 05, 2021
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors 2019
Please see the full-text version of this guideline https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-treatment-of-adults-with-metastatic-bra-2 for the target population of each recommendation listed below.
SURGERY FOR METASTATIC BRAIN TUMORS AT NEW DIAGNOSIS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo Brain metastases surgery, Stereotactic radiosurgery for brain metastases (SRS), or whole brain radiotherapy (WBRT)?
RECOMMENDATIONS:
Level of Evidence 1: Surgery + WBRT is recommended as first-line treatment in patients with single brain metastases with favorable performance status and limited extracranial disease to extend overall survival, median survival, and local control.
Level of Evidence 3: Surgery plus SRS is recommended to provide survival benefit in patients with metastatic brain tumors
Level of Evidence 3: Multimodal treatments including either surgery + WBRT + SRS boost or surgery + WBRT are recommended as alternatives to WBRT + SRS in terms of providing overall survival and local control benefits.
SURGERY AND RADIATION FOR METASTATIC BRAIN TUMORS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgical resection followed by WBRT, SRS, or another combination of these modalities?
RECOMMENDATIONS:
Level 1: Surgery + WBRT is recommended as superior treatment to WBRT alone in patients with single brain metastases.
Level 3: Surgery + SRS is recommended as an alternative to treatment with SRS alone to benefit overall survival.
Level 3: It is recommended that SRS alone be considered equivalent to surgery + WBRT.
SURGERY FOR RECURRENT METASTATIC BRAIN TUMORS QUESTION: Should patients with recurrent metastatic brain tumors undergo surgical resection?
RECOMMENDATIONS:
Level 3: Craniotomy is recommended as a treatment for intracranial recurrence after initial surgery or SRS. SURGICAL TECHNIQUE AND RECURRENCE QUESTION A: Does the surgical technique (en bloc resection or piecemeal resection) affect recurrence?
RECOMMENDATION:
Level 3: En bloc resection of the tumor, as opposed to piecemeal resection, is recommended to decrease the risk of postoperative leptomeningeal disease when resecting single brain metastases.
QUESTION B:
Does the extent of surgical resection (gross total resection or subtotal resection) affect recurrence?
RECOMMENDATION:
Level 3: Gross total resection is recommended over subtotal resection in Recursive partitioning analysis class 1 class I patients to improve overall survival and prolong time to recurrence. 1)