New ASTRO Brain Metastases Guideline: Treatment Selection Should Mirror Most Important Endpoint

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(ChemotherapyAdvisor) – Survival, local treated lesion control, distant brain control, or neurocognitive preservation — what is the most important endpoint for a patient newly diagnosed with intraparenchymal brain metastases? The answer to that question should be the deciding factor in selecting the most appropriate radiotherapeutic and/or surgical intervention, according to a new guideline developed by the American Society for Radiation Oncology (ASTRO) and published in Practical Radiation Oncology February 8.

The guideline, developed by an international multidisciplinary task force, “should help clinicians make solid evidence-based decisions, while still allowing best clinical judgment to fill in knowledge gaps not readily addressed by the guideline,” said Eric L. Chang, MD, a radiation oncologist at the University of Southern California Keck School of Medicine.

Brain metastases occur in an estimated 20% to 40% of patients with cancer. Guidance is provided on using whole-brain radiotherapy (WBRT), radiosurgery and/or surgery for three categories of patients based on tumor factors and prognosis:

1. Single brain metastasis and good prognosis (expected survival 3 months or more).

2. Multiple brain metastases and good prognosis (expected survival 3 months or more).

3. Patient with poor prognosis (expected survival <3 months).

 “For selected patients with single brain metastasis, the use of surgery or radiosurgery has been shown to improve survival, and this should be the primary consideration,” the guideline states. Dose fractionation schedules, the role of radiosensitizers or chemotherapy with WBRT, and palliative supportive care along vs. WBRT in patients with multiple brain metastases are some of the many topics addressed in the guideline.

Abstract

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