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A multidisciplinary management algorithm for brain metastases
Alexander Ramos1, Alexandra Giantini-Larsen1, Susan C Pannullo1
1Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA.
Neuro-Oncology Advances
|December 19, 2022
Summary
Brain metastases management is challenging, especially with multiple lesions. A new algorithm suggests omitting whole-brain radiation therapy for most patients, improving treatment strategies.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Medical Oncology
Background:
- Brain metastases incidence remains a clinical challenge.
- Management of multiple brain lesions is complex.
- Advances in systemic therapy improve survival but complicate local treatment.
Purpose of the Study:
- To review evidence for brain metastases management.
- To propose a multidisciplinary management algorithm.
- To incorporate precision medicine into treatment strategies.
Main Methods:
- Review of current literature on brain metastases.
- Development of a multidisciplinary treatment algorithm.
- Integration of surgery, radiation, and systemic therapies.
- Consideration of precision medicine-guided treatments.
Main Results:
- Oligometastatic disease (1-4 lesions) is manageable with current techniques.
- Multiple brain metastases pose significant management challenges.
- Whole-brain radiation therapy (WBRT) may be avoidable upfront for many patients.
Conclusions:
- A multidisciplinary approach is crucial for optimal brain metastases care.
- Precision medicine should guide treatment selection.
- Whole-brain radiation therapy can likely be omitted in most patients as initial therapy.
