• New Guidelines for Managing Adults with Metastatic Brain Tumors

    • Feb 01, 2019
    • Robert M. Starke, MD MSc

    • Tumor

    Cerebral metastatic brain tumors are a common condition is a common condition. It is imperative to have a broad understanding of the literature to make evidence-based management decisions.  The newly released “Systematic Review and Evidence-Based Guidelines on Managing Adults with Metastatic Brain Tumors” was developed by systematically reviewing clinically relevant subjects and providing graded recommendations for management.

    Clinical subjects included in these guidelines:

    1. Role of Surgery
    2. Whole brain radiation (WBRT)
    3. Stereotactic radiosurgery (SRS)
    4. Chemotherapy
    5. Treatment of multiple metastasis
    6. Steroid management
    7. Prophylactic anticonvulsants
    8. Investigational therapies


    Surgery and WBRT is recommended as first-line treatment in patients with single brain metastasis, but surgery with SRS or SRS alone is an alternative for select patients. A standard WBRT schedule (i.e. 30 Gy in 10 fractions or biological equivalent dose) is recommended. For patients with 2 to 4 brain metastasis, SRS is recommended instead of WBR when the cumulative volume is <7ml and may be a treatment option for patients with more than 4 metastases having a cumulative volume <7ml. It is recommended that WBRT therapy can be added to SRS to improve local and distant control, keeping in mind the potential for worsened neurocognitive outcomes. In patients with 2 to 3 metastases not amenable to surgery, the addition of SRS to WBRT is not recommended to improve surgical beyond that obtained with WBRT alone. Some topics do not have sufficient data to provide a recommendation.  These deficiencies are useful in guiding future research.  These publications provide a detailed overview of management of these patients.



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