• Mintz AP, Perry J, Laperriere N, Cairncross G, Chambers A, Spithoff K, Neuro-oncology Disease Site Group. Management of single brain metastases: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Aug 15. 26 p. (Evidence-based series; no. 9-1). [29 references]

• Surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis amenable to complete excision. Since treatment in this disease is considered palliative, invasive local treatments must be individualized. Patients with lesions requiring emergency decompression due to intracranial hypertension were excluded from the randomized control trials but should be considered to be surgical candidates.
• Postoperative whole brain radiotherapy (WBRT) should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis. The optimal dose and fractionation schedule for whole brain radiation therapy is 3,000 cGy in 10 fractions or 2,000 cGy in five fractions.
• Stereotactic radiosurgery (SRS) boost should be considered following WBRT for patients with single metastases. There is insufficient evidence to recommend SRS alone as single modality therapy.

None provided

The recommendations are supported by randomized controlled trials, prospective case series, retrospective reviews, and 1 meta-analysis.

• Mintz AP, Perry J, Laperriere N, Cairncross G, Chambers A, Spithoff K, Neuro-oncology Disease Site Group. Management of single brain metastases: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Aug 15. 26 p. (Evidence-based series; no. 9-1). [29 references]

Not applicable: The guideline was not adapted from another source.

2004 Aug 17 (revised 2006 Aug 15)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Neuro-oncology Disease Site Group

Members of the Neuro-oncology Disease Site Group (DSG) involved in the development of this Evidence-Based Series were polled for potential conflicts of interest. No conflicts were declared.

None available

This summary was completed by ECRI on October 6, 2004. The information was verified by the guideline developer on October 20, 2004. This NGC summary was updated by ECRI Institute on June 5, 2007. The information was verified by the guideline developer on June 13, 2007.