a
Aer consultation with a MDT.
b
Upfront systemic therapy can be discussed for select cases.
Prognosis
Prior WBRT
or SRS
Type of
recurrence?
Type of
recurrence?
Patients who have received prior treatment
Favorable prognosis
Prior SRS
Yes, symptomatic mass
effect
Diffuse
recurrence
Diffuse
recurrence
WBRT-M/
HA, trial of
systemic
therapy,
clinical trial, or
BSC
A trial of
systemic
therapy,
clinical
trial, repeat
reduced dose
WBRT-M, or
BSC
Repeat SRS,
surgery,
WBRT-M/
HA, trial of
systemic
therapy, or
clinical trial
SRS, surgery,
trial of
systemic
therapy, or
clinical trial/
other palliative
options
WBRT/M-HA
Limited
recurrence
Limited
recurrence
Prior WBRT
Poor prognosis
