Management of single brain metastasis: a practice guideline

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Approximately 15%-30% of cancer patients develop brain metastases.
• Management of single brain metastasis varies, necessitating evidence-based guidelines.

Purpose of the Study:

• To systematically review evidence on surgical resection, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS) for single brain metastasis.
• To provide practice guideline recommendations for managing patients with single brain metastasis.

Main Methods:

• Systematic literature search of Medline, CancerLit, Embase, and Cochrane Library databases.
• Inclusion of randomized controlled trials (RCTs), nonrandomized prospective, and retrospective studies.
• Review and approval by the Neuro-oncology Disease Site Group (DSG) and external practitioners.

Main Results:

• Two of three RCTs showed survival benefit with surgical resection versus WBRT alone.
• WBRT after resection reduced tumor recurrence and death from neurologic causes.
• WBRT plus SRS improved median survival compared to WBRT alone; evidence comparing SRS to surgery is limited.

Conclusions:

• Surgical excision is recommended for eligible patients with single brain metastasis.
• Postoperative WBRT should be considered to reduce recurrence risk.
• WBRT followed by SRS boost is an alternative to surgery; SRS alone lacks sufficient evidence.