Michael A Vogelbaum1, Paul D Brown2, Hans Messersmith3, Priscilla K Brastianos4, Stuart Burri5, Dan Cahill4, Ian F Dunn6, Laurie E Gaspar7,8, Na Tosha N Gatson9,10, Vinai Gondi11, Justin T Jordan4, Andrew B Lassman12, Julia Maues13, Nimish Mohile14, Navid Redjal15, Glen Stevens16, Erik Sulman17, Martin van den Bent18, H James Wallace19, Jeffrey S Weinberg20, Gelareh Zadeh21, David Schiff22. 1. Moffit Cancer Center, Tampa, FL. 2. Mayo Clinic Cancer Center, Rochester, MN. 3. American Society of Clinical Oncology ASCO, Alexandria, VA. 4. Massachusetts General Hospital, Boston, MA. 5. Levine Cancer Institute at Atrium Health, Charlotte, NC. 6. Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK. 7. University of Colorado School of Medicine, Aurora, CO. 8. University of Texas MD Anderson Cancer Center Northern Colorado, Greeley, CO. 9. Banner MD Anderson Cancer Center, Phoenix, AZ. 10. Geisinger Neuroscience Institute. Danville, PA. 11. Northwestern Medicine Cancer Center Warrenville and Proton Center, Warrenville, IL. 12. Columbia University Irving Medical Center, New York, NY. 13. Georgetown Breast Cancer Advocates, Washington, DC. 14. University of Rochester Medical Center, Rochester, NY. 15. Capital Health Medical Center - Hopewell Campus, Princeton, NJ. 16. Cleveland Clinic, Cleveland, OH. 17. YU Langone Health, New York City, NY. 18. Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 19. University of Vermont, Burlington, VT. 20. University of Texas MD Anderson Cancer Center, Houston, TX. 21. University of Toronto, Toronto, Ontario, Canada. 22. University of Virginia Medical Center, Charlottesville, VA.
Abstract
PURPOSE: To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors. METHODS: ASCO convened an Expert Panel and conducted a systematic review of the literature. RESULTS: Thirty-two randomized trials published in 2008 or later met eligibility criteria and form the primary evidentiary base. RECOMMENDATIONS: Surgery is a reasonable option for patients with brain metastases. Patients with large tumors with mass effect are more likely to benefit than those with multiple brain metastases and/or uncontrolled systemic disease. Patients with symptomatic brain metastases should receive local therapy regardless of the systemic therapy used. For patients with asymptomatic brain metastases, local therapy should not be deferred unless deferral is specifically recommended in this guideline. The decision to defer local therapy should be based on a multidisciplinary discussion of the potential benefits and harms that the patient may experience. Several regimens were recommended for non-small-cell lung cancer, breast cancer, and melanoma. For patients with asymptomatic brain metastases and no systemic therapy options, stereotactic radiosurgery (SRS) alone should be offered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma. SRS alone to the surgical cavity should be offered to patients with one to two resected brain metastases. SRS, whole brain radiation therapy, or their combination are reasonable options for other patients. Memantine and hippocampal avoidance should be offered to patients who receive whole brain radiation therapy and have no hippocampal lesions and 4 months or more expected survival. Patients with asymptomatic brain metastases with either Karnofsky Performance Status ≤ 50 or Karnofsky Performance Status < 70 with no systemic therapy options do not derive benefit from radiation therapy.Additional information is available at www.asco.org/neurooncology-guidelines.
PURPOSE: To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors. METHODS: ASCO convened an Expert Panel and conducted a systematic review of the literature. RESULTS: Thirty-two randomized trials published in 2008 or later met eligibility criteria and form the primary evidentiary base. RECOMMENDATIONS: Surgery is a reasonable option for patients with brain metastases. Patients with large tumors with mass effect are more likely to benefit than those with multiple brain metastases and/or uncontrolled systemic disease. Patients with symptomatic brain metastases should receive local therapy regardless of the systemic therapy used. For patients with asymptomatic brain metastases, local therapy should not be deferred unless deferral is specifically recommended in this guideline. The decision to defer local therapy should be based on a multidisciplinary discussion of the potential benefits and harms that the patient may experience. Several regimens were recommended for non-small-cell lung cancer, breast cancer, and melanoma. For patients with asymptomatic brain metastases and no systemic therapy options, stereotactic radiosurgery (SRS) alone should be offered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma. SRS alone to the surgical cavity should be offered to patients with one to two resected brain metastases. SRS, whole brain radiation therapy, or their combination are reasonable options for other patients. Memantine and hippocampal avoidance should be offered to patients who receive whole brain radiation therapy and have no hippocampal lesions and 4 months or more expected survival. Patients with asymptomatic brain metastases with either Karnofsky Performance Status ≤ 50 or Karnofsky Performance Status < 70 with no systemic therapy options do not derive benefit from radiation therapy.Additional information is available at www.asco.org/neurooncology-guidelines.
Authors: Ayal A Aizer; Nayan Lamba; Manmeet S Ahluwalia; Kenneth Aldape; Adrienne Boire; Priscilla K Brastianos; Paul D Brown; D Ross Camidge; Veronica L Chiang; Michael A Davies; Leland S Hu; Raymond Y Huang; Timothy Kaufmann; Priya Kumthekar; Keng Lam; Eudocia Q Lee; Nancy U Lin; Minesh Mehta; Michael Parsons; David A Reardon; Jason Sheehan; Riccardo Soffietti; Hussein Tawbi; Michael Weller; Patrick Y Wen Journal: Neuro Oncol Date: 2022-10-03 Impact factor: 13.029
Authors: Eric J Lehrer; Brianna M Jones; Daniel R Dickstein; Sheryl Green; Isabelle M Germano; Joshua D Palmer; Nadia Laack; Paul D Brown; Vinai Gondi; Jeffrey S Wefel; Jason P Sheehan; Daniel M Trifiletti Journal: Front Oncol Date: 2022-06-30 Impact factor: 5.738