Vinai Gondi1, Glenn Bauman2, Lisa Bradfield3, Stuart H Burri4, Alvin R Cabrera5, Danielle A Cunningham6, Bree R Eaton7, Jona A Hattangadi-Gluth8, Michelle M Kim9, Rupesh Kotecha10, Lianne Kraemer11, Jing Li12, Seema Nagpal13, Chad G Rusthoven14, John H Suh15, Wolfgang A Tomé16, Tony J C Wang17, Alexandra S Zimmer18, Mateo Ziu19, Paul D Brown6. 1. Department of Radiation Oncology, Northwestern Medicine Cancer Center and Proton Center, Warrenville, Illinois. Electronic address: vinai.gondi@nm.org. 2. Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre & Western University, London, Ontario, Canada. 3. American Society for Radiation Oncology, Arlington, Virginia. 4. Department of Radiation Oncology, Atrium Health, Charlotte, North Carolina. 5. Department of Radiation Oncology, Kaiser Permanente, Seattle, Washington. 6. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 7. Department of Radiation Oncology, Emory University, Atlanta, Georgia. 8. Department of Radiation Oncology, University of California, San Diego, California. 9. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 10. Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida. 11. Patient representative, Chicago, Illinois. 12. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. 13. Division of Neuro-oncology, Department of Neurology, Stanford University, Stanford, California. 14. Department of Radiation Oncology, University of Colorado, Aurora, Colorado. 15. Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio. 16. Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. 17. Department of Radiation Oncology, Columbia University, New York, New York. 18. Women's Malignancies Branch, National Institutes of Health/National Cancer Institute, Bethesda, Maryland. 19. Department of Neurosciences, INOVA Neuroscience and INOVA Schar Cancer Institute, Falls Church, Virginia.
Abstract
PURPOSE: This guideline provides updated evidence-based recommendations addressing recent developments in the management of patients with brain metastases, including advanced radiation therapy techniques such as stereotactic radiosurgery (SRS) and hippocampal avoidance whole brain radiation therapy and the emergence of systemic therapies with central nervous system activity. METHODS: The American Society for Radiation Oncology convened a task force to address 4 key questions focused on the radiotherapeutic management of intact and resected brain metastases from nonhematologic solid tumors. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Strong recommendations are made for SRS for patients with limited brain metastases and Eastern Cooperative Oncology Group performance status 0 to 2. Multidisciplinary discussion with neurosurgery is conditionally recommended to consider surgical resection for all tumors causing mass effect and/or that are greater than 4 cm. For patients with symptomatic brain metastases, upfront local therapy is strongly recommended. For patients with asymptomatic brain metastases eligible for central nervous system-active systemic therapy, multidisciplinary and patient-centered decision-making to determine whether local therapy may be safely deferred is conditionally recommended. For patients with resected brain metastases, SRS is strongly recommended to improve local control. For patients with favorable prognosis and brain metastases receiving whole brain radiation therapy, hippocampal avoidance and memantine are strongly recommended. For patients with poor prognosis, early introduction of palliative care for symptom management and caregiver support are strongly recommended. CONCLUSIONS: The task force has proposed recommendations to inform best clinical practices on the use of radiation therapy for brain metastases with strong emphasis on multidisciplinary care.
PURPOSE: This guideline provides updated evidence-based recommendations addressing recent developments in the management of patients with brain metastases, including advanced radiation therapy techniques such as stereotactic radiosurgery (SRS) and hippocampal avoidance whole brain radiation therapy and the emergence of systemic therapies with central nervous system activity. METHODS: The American Society for Radiation Oncology convened a task force to address 4 key questions focused on the radiotherapeutic management of intact and resected brain metastases from nonhematologic solid tumors. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Strong recommendations are made for SRS for patients with limited brain metastases and Eastern Cooperative Oncology Group performance status 0 to 2. Multidisciplinary discussion with neurosurgery is conditionally recommended to consider surgical resection for all tumors causing mass effect and/or that are greater than 4 cm. For patients with symptomatic brain metastases, upfront local therapy is strongly recommended. For patients with asymptomatic brain metastases eligible for central nervous system-active systemic therapy, multidisciplinary and patient-centered decision-making to determine whether local therapy may be safely deferred is conditionally recommended. For patients with resected brain metastases, SRS is strongly recommended to improve local control. For patients with favorable prognosis and brain metastases receiving whole brain radiation therapy, hippocampal avoidance and memantine are strongly recommended. For patients with poor prognosis, early introduction of palliative care for symptom management and caregiver support are strongly recommended. CONCLUSIONS: The task force has proposed recommendations to inform best clinical practices on the use of radiation therapy for brain metastases with strong emphasis on multidisciplinary care.
Authors: Zhengting Chen; Lingli Zhou; Min Zhao; Ke Cao; Yanqing Li; Xiaoling Liu; Yu Hou; Lan Li; Li Wang; Li Chang; Mei Yang; Wenhui Li; Yaoxiong Xia Journal: BMC Cancer Date: 2022-09-24 Impact factor: 4.638