Treatment
Recommendation 3.3
➤ SRS alone should be offered to patients with 1 to 2 resected brain
metastases if the surgical cavity can be safely treated and considering
the extent of remaining intracranial disease. (IC-L)
Qualifying Statement: The randomized trials upon which this recommendation is based
were of single-fraction SRS and conventional WBRT (without radioprotectant strategies of
memantine or hippocampal avoidance).
(Moderate recommendation; EB-I)
Recommendation 3.4
➤ SRS, WBRT, and the combination of SRS plus WBRT are all reasonable
options for patients with more than 4 unresected or more than 2
resected brain metastases and better performance status (e.g., KPS
≥70). SRS may be preferred for patients with better prognosis or where
systemic therapy that is known to be active in the central nervous
system is available. (Weak recommendation; IC-L)
Recommendation 3.5
➤ Memantine and hippocampal avoidance should be offered to patients
who will receive WBRT and have no hippocampal lesions and 4 months
or more expected survival. (Strong recommendation; EB-H)
Recommendation 3.6
➤ Radiation sensitizing agents should not be offered to patients. (Strong
recommendation; EB-L)
Recommendation 4.1
➤ For patients who will receive both radiation therapy and surgery, no
recommendation regarding the specific sequence of therapy can be
made. (IC-L)
