Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

J Clin Oncol. 2021 Dec 21:JCO2102314. doi: 10.1200/JCO.21.02314. Online ahead of print.ABSTRACTPURPOSE: 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...

Source: Clinical Breast Cancer - December 21, 2021 Category: Cancer & Oncology Authors: Michael A Vogelbaum Paul D Brown Hans Messersmith Priscilla K Brastianos Stuart Burri Dan Cahill Ian F Dunn Laurie E Gaspar Na Tosha N Gatson Vinai Gondi Justin T Jordan Andrew B Lassman Julia Maues Nimish Mohile Navid Redjal Glen Stevens Erik Sulman Mart Source Type: research