ASCO GUIDELINES Bundle

Treatment for Brain Metastases

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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)

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