Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

Vogelbaum, Michael A.; Brown, Paul D.; Messersmith, Hans; Brastianos, Priscilla K.; Burri, Stuart H.; Cahill, Daniel P.; Dunn, Ian F.; Gaspar, Laurie E.; Gatson, Na Tosha N; Gondi, Vinai; Jordan, Justin; Lassman, Andrew B.; Maues, Julia; Mohile, Nimish; Redjal, Navid; Stevens, Glen; Sulman, Erik P.; Bent, Martin van den; Wallace, H. James; Weinberg, Jeffrey S.; Zadeh, Gelareh; Schiff, David

doi:10.1093/neuonc/noab262

Cited by 36 publications

(73 citation statements)

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“…Integration of Palliative Care into Standard Oncology Practice 7 (http://ascopubs.org/doi/10.1200/JCO.2016.70.1474)Patient-Clinician Communication 8 (http://ascopubs.org/doi/10.1200/JCO.2017.75.2311)Treatment of Brain Metastases: ASCO/SNO/ASTRO Guideline 1 (https://ascopubs.org/doi/10.1200/JCO.21.02314)…”

Section: Additional Resourcesmentioning

confidence: 99%

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Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline

Schiff

Messersmith

Brastianos

et al. 2022

JCO

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PURPOSE American Society of Radiation Oncology (ASTRO) has developed a guideline on appropriate radiation therapy for brain metastases. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS “Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline” 2 was reviewed for developmental rigor by methodologists. An ASCO Endorsement Panel subsequently reviewed the content and the recommendations. RESULTS The ASCO Endorsement Panel determined that the recommendations from the ASTRO guideline, published May 6, 2022, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorses “Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline.” 2 RECOMMENDATIONS Within the guideline, stereotactic radiosurgery (SRS) is recommended for patients with Eastern Cooperative Oncology Group performance status of 0-2 and up to four intact brain metastases, and conditionally recommended for patients with up to 10 intact brain metastases. The guideline provides detailed dosing and fractionation recommendations on the basis of the size of the metastases. For patients with resected brain metastases, radiation therapy (SRS or whole-brain radiation therapy [WBRT]) is recommended to improve intracranial disease control; if there are limited additional brain metastases, SRS is recommended over WBRT. For patients with favorable prognosis and brain metastases ineligible for surgery and/or SRS, WBRT is recommended with hippocampal avoidance where possible and the addition of memantine is recommended. For patients with brain metastases, limiting the single-fraction V12Gy to brain tissue to ≤ 10 cm3 is conditionally recommended. Additional information is available at www.asco.org/neurooncology-guidelines .

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Section: Additional Resourcesmentioning

confidence: 99%

“…Treatment of Brain Metastases: ASCO-SNO-ASTRO Guideline 1 (https://ascopubs.org/doi/10.1200/JCO.21.02314)…”

Section: Additional Resourcesmentioning

confidence: 99%

Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline

Schiff

Messersmith

Brastianos

et al. 2022

JCO

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“…Given these data, when WBRT is used, clinicians should add memantine (WB-M) and, in addition, HA if no metastases are present within 5 mm of the hippocampus. 5,9,11…”

Section: Introductionmentioning

confidence: 99%

“…However, ASCO conducted a separate systematic review for a separate guideline that was available to inform this HER2-positive specific guideline. 5…”

Section: Introductionmentioning

confidence: 99%

“…11 Given these data, when WBRT is used, clinicians should add memantine (WB-M) and, in addition, HA if no metastases are present within 5 mm of the hippocampus. 5,9,11 The utilization of WBRT (plus memantine and hippocampal avoidance [WB-M + HA]) and SRS has continued to evolve with a disease-specific and patient-specific approach.Since the previous update, emerging evidence presents a new option to defer local therapy for a subset of the target population. The guideline discusses this evidence under Systemic Therapy.A particularly important consideration for patients with HER2-positive breast cancer and brain metastases is the role of WB-M + HA versus surgery, SRS, and hypofractionated stereotactic radiotherapy (HSRT), in the management of limited (defined as two-four metastases) brain metastatic disease.There are no head-to-head trials comparing efficacy and toxicity of local therapy alone (surgery, SRS, and HSRT) versus WB-M + HA ± SRS.…”

Section: Introductionmentioning

confidence: 99%

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Management of Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer and Brain Metastases: ASCO Guideline Update

Ramakrishna

Anders

Lin

et al. 2022

JCO

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PURPOSE To provide updated evidence- and consensus-based guideline recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2)–positive advanced breast cancer up to 2021. METHODS An Expert Panel conducted a targeted systematic literature review (for both systemic therapy for non-CNS metastases and for CNS metastases of HER2+ guideline updates) that identified 545 articles. Outcomes of interest included overall survival, progression-free survival, and adverse events. RESULTS Of the 545 publications identified and reviewed, six on systemic therapy were identified to form the evidentiary basis for the systemic therapy for CNS metastases guideline recommendations. RECOMMENDATIONS Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Memantine and hippocampal avoidance should be added to whole-brain radiotherapy when possible. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. There are insufficient data to recommend for or against performing routine magnetic resonance imaging to screen for brain metastases; clinicians should have a low threshold for magnetic resonance imaging of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer. Additional information is available at www.asco.org/breast-cancer-guidelines .

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Screening brain MRI in inflammatory breast cancer: Is it time?

Dhakal

Anders

2022

Cancer

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The study of brain metastasis (BrM) in patients with inflammatory breast cancer (IBC) by Warren et al. that accompanies this editorial has reported a high incidence of BrM and poor survival after BrM diagnosis. The question rises: should we adopt routine brain MRI in patients with IBC for early detection of BrMs and will this make a difference in survival and quality of life of patients? This editorial tries to approach these questions.

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Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

Cited by 36 publications

References 0 publications

Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline

Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline

Management of Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer and Brain Metastases: ASCO Guideline Update

Screening brain MRI in inflammatory breast cancer: Is it time?

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