• Supportive Care Guidelines Group, Neuro-oncology Disease Site Group. Tsao MN, Laetsch NS, Wong RKS, Laperriere N. Management of brain metastases: role of radiotherapy alone or in combination with other treatment modalities [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 Mar. 35 p. (Practice guideline report; no. 13-4). [36 references]

Radiotherapy and Surgery for Single Brain Metastasis

• 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.
• Postoperative whole brain radiotherapy should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis.

Radiotherapy for Multiple Brain Metastases

• It is recommended that the whole brain be irradiated for multiple brain metastases. Commonly used dose fractionation schedules are 3,000 cGy in 10 fractions or 2,000 cGy in five fractions.
• Altered dose fractionation whole brain radiotherapy schedules have not demonstrated any advantages in terms of overall survival or neurologic function relative to more commonly used fractionation schedules.
• The use of radiosensitizers is not recommended outside research studies.
• The optimal use of radiosurgery in the treatment of brain metastases remains to be defined. In patients with one to three brain metastases (less than 3 cm in size) and limited or controlled extracranial disease, radiosurgery may be considered to improve local tumour control either as boost therapy with whole brain radiation or at the time of relapse after whole brain radiotherapy.

Chemotherapy and Whole Brain Radiotherapy

The use of chemotherapy as primary therapy for brain metastases (with whole brain radiotherapy used for those whose intracranial metastases fail to respond) or the use of chemotherapy with whole brain radiotherapy to treat brain metastases remains experimental.

Supportive Care and Whole Brain Radiotherapy

Supportive care alone without whole brain radiotherapy is an option (for example, in patients with poor performance status and progressive extracranial disease). However, there is a lack of Level 1 evidence to guide practitioners as to which subsets of patients with brain metastases should be managed with supportive care alone without whole brain radiotherapy.

None provided

The recommendations are supported by randomized clinical trials.

• Supportive Care Guidelines Group, Neuro-oncology Disease Site Group. Tsao MN, Laetsch NS, Wong RKS, Laperriere N. Management of brain metastases: role of radiotherapy alone or in combination with other treatment modalities [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 Mar. 35 p. (Practice guideline report; no. 13-4). [36 references]

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

2004 Mar 30

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

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), 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

Supportive Care Guidelines Group
Neuro-oncology Disease Site Group

Members of the Supportive Care Guidelines Group (SCGG) disclosed potential conflict of interest information.

None available

This NGC summary was completed by ECRI on June 29, 2004. The information was verified by the guideline developer on July 19, 2004.