[Revised guideline 'Brain metastases': More treatment options]

Area of Science:

• Neurology
• Oncology
• Neurosurgery

Background:

• Brain metastases represent a significant challenge in cancer care, necessitating updated clinical guidelines.
• Treatment strategies for brain metastases require a comprehensive, multidisciplinary approach for optimal patient outcomes.

Purpose of the Study:

• To present the updated Netherlands Society of Neurology guideline on the management of brain metastases.
• To highlight significant changes in treatment recommendations, particularly concerning surgical and radiological interventions.

Main Methods:

• Review and synthesis of current evidence and expert consensus on brain metastasis treatment.
• Development of updated recommendations based on multidisciplinary team input.

Main Results:

• Neurosurgical resection is considered for patients with multiple brain metastases and a dominant symptomatic lesion if clinically stable.
• Stereotactic radiosurgery is an option for up to 10 brain metastases, contingent on size and number.
• Whole brain radiotherapy indications are limited, with caution advised for patients with Karnofsky Performance Status <70.
• Targeted or immune therapy may be considered for small, asymptomatic brain metastases without locoregional treatment.

Conclusions:

• The updated guideline provides refined, individualized treatment strategies for brain metastases.
• Emphasis on a multidisciplinary approach is crucial for managing complex cases of brain metastases.
• Treatment decisions should balance efficacy with patient condition and metastasis characteristics.