Key Points
➤ In the United States, it is estimated that between 8% and 10% of patients
with cancer will develop brain metastases representing ~200,000 new
patients with brain metastases every year.
➤ The most likely primary cancers to seed brain metastases are melanoma,
lung adenocarcinoma, and those from lung, breast, melanoma, renal,
kidney, esophagus, and, head and neck.
➤ This guideline was developed by a multi-disciplinary team of medical
oncologists, neurosurgeons, neuro-oncologists and radiation oncologists,
and it integrates the latest evidence supporting the use of surgery,
radiation, and medical therapies for patients with CNS metastases.
Treatment
Recommendation 1.1
➤ Surgery may be offered for patients with brain metastases, considering
the following factors:
• Patients with suspected brain metastases without a primary cancer diagnosis may
benefit from surgery to attain a diagnosis and undergo tumor removal.
• Patients with large tumors with mass effect likely benefit from surgery.
Patients with multiple brain metastases and/or uncontrolled systemic disease are less
likely to benefit from surgery unless the remaining disease is controllable via other
measures.
(Moderate recommendation; EB-mixed)
Recommendation 1.2
➤ Where surgery is considered, no recommendation regarding the method of
resection (piecemeal vs. en bloc) can be made. (IC-L)
Recommendation 1.3
➤ No recommendation can be made for or against LITT. (IC-L)