• Neurosurgery · Mar 2019

    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, and Jeffrey J Olson.
    • Department of Neurosurgery, St. Rita Medical Center, Lima, Ohio.
    • Neurosurgery. 2019 Mar 1; 84 (3): E180-E182.

    Target PopulationThese recommendations apply to adult patients newly diagnosed with multiple (more than 1) brain metastases.Question 1In what circumstances should whole brain radiation therapy be recommended to improve tumor control and survival in patients with multiple brain metastases?RecommendationLevel 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 2In what circumstances should stereotactic radiosurgery be recommended to improve tumor control and survival in patients with multiple brain metastases?RecommendationsLevel 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 3In what circumstances should surgery be recommended to improve tumor control and survival in patients with multiple brain metastases?RecommendationLevel 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.Copyright © 2019 by the Congress of Neurological Surgeons.

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