Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Treatment Options for Adults With Multiple Metastatic Brain Tumors

Mario Ammirati; Brian V Nahed; David Andrews; Clark C Chen; Jeffrey J Olson

doi:10.1093/neuros/nyy548

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Treatment Options for Adults With Multiple Metastatic Brain Tumors

Neurosurgery. 2019 Mar 1;84(3):E180-E182. doi: 10.1093/neuros/nyy548.

Authors

Mario Ammirati^{1

2}, Brian V Nahed³, David Andrews⁴, Clark C Chen⁵, Jeffrey J Olson⁶

Affiliations

¹ Department of Neurosurgery, St. Rita Medical Center, Lima, Ohio.
² Department of Biology, College of Science and Technology and Sbarro Health Research Organization, Temple University, Philadelphia, Pennsylvania.
³ Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.
⁴ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
⁵ Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota.
⁶ Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.

PMID: 30629219
DOI: 10.1093/neuros/nyy548

Abstract

Target population: These recommendations apply to adult patients newly diagnosed with multiple (more than 1) brain metastases.

Question 1: In what circumstances should whole brain radiation therapy be recommended to improve tumor control and survival in patients with multiple brain metastases?

Recommendation: Level 2: It is recommended that whole brain radiation therapy can be added to stereotactic radiosurgery to improve local and distant control keeping in mind the potential for worsened neurocognitive outcomes and that there is unlikely to be a significant impact on overall survival.

Question 2: In what circumstances should stereotactic radiosurgery be recommended to improve tumor control and survival in patients with multiple brain metastases?

Recommendations: Level 1: In patients with 2 to 3 brain metastases not amenable to surgery, the addition of stereotactic radiosurgery to whole brain radiation therapy is not recommended to improve survival beyond that obtained with whole brain radiation therapy alone. Level 3: The use of stereotactic radiosurgery alone is recommended to improve median overall survival for patients with more than 4 metastases having a cumulative volume < 7 cc.

Question 3: In what circumstances should surgery be recommended to improve tumor control and survival in patients with multiple brain metastases?

Recommendation: Level 3: In patients with multiple brain metastases, tumor resection is recommended in patients with lesions inducing symptoms from mass effect that can be reached without inducing new neurological deficit and who have control of their cancer outside the nervous system.The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_6.

Keywords: Brain metastases; Cerebral metastases; Multiple metastases; Radiotherapy; Resection; Whole brain radiotherapy.

Publication types

Systematic Review

MeSH terms

Adult
Brain Neoplasms / secondary*
Brain Neoplasms / surgery*
Congresses as Topic / standards
Female
Humans
Male
Neurosurgeons / standards*
Practice Guidelines as Topic / standards*
Radiosurgery
Treatment Outcome