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ASTRO recently published the guideline for the management of patients with brain metastases...


ASTRO (American Society for Radiation Oncology) Guideline For Brain Metastases


ASTRO recently published the guideline for the management of patients with brain metastases. The guideline was organized based on a systematic review and the recommendations were developed by using a system for grading evidence quality and recommendation asset.


The recommendations were:

• Strong recommendations for radiosurgery (SRS) for patients with limited brain metastases and ECOG performance status 0 to 2;

• Multidisciplinary discussion with neurosurgery for surgical resection for patients with tumors causing mass effect and/or that are greater than 4 cm;

• Upfront local therapy is strongly recommended for patients with symptomatic disease;

• Multidisciplinary discussion and patient-centered decision-making to determine whether local therapy may be safely deferred for patients with asymptomatic brain metastases eligible for central nervous system-active systemic therapy;

• Post-operative SRS to the tumor bed is strongly recommended to improve local control;

• Hippocampal avoidance and memantine are strongly recommended for patients with favorable prognosis and brain metastases receiving whole brain radiation therapy;

• Early introduction of palliative care for symptom management and caregiver support are strongly recommended for patients with poor prognosis.


Gustavo Nader Marta

Radiation Oncologist at Hospital Sírio-Libanês

President of SNOLA


Reference:Gondi V, Bauman G, Bradfield L, Burri SH, Cabrera AR, Cunningham DA, Eaton BR, Hattangadi-Gluth JA, Kim MM, Kotecha R, Kraemer L, Li J, Nagpal S, Rusthoven CG, Suh JH, Tomé WA, Wang TJC, Zimmer AS, Ziu M, Brown PD. Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2022 May 6:S1879-8500(22)00054-6.

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