Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

Author:

Vogelbaum Michael A.1ORCID,Brown Paul D.2ORCID,Messersmith Hans3ORCID,Brastianos Priscilla K.4ORCID,Burri Stuart5,Cahill Dan4,Dunn Ian F.6,Gaspar Laurie E.78,Gatson Na Tosha N.910ORCID,Gondi Vinai11,Jordan Justin T.4ORCID,Lassman Andrew B.12ORCID,Maues Julia13ORCID,Mohile Nimish14,Redjal Navid15ORCID,Stevens Glen16ORCID,Sulman Erik17ORCID,van den Bent Martin18ORCID,Wallace H. James19ORCID,Weinberg Jeffrey S.20,Zadeh Gelareh21,Schiff David22ORCID

Affiliation:

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 .

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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