The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline
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The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline

  • Author(s): Ammirati, Mario
  • Cobbs, Charles S.
  • Linskey, Mark E.
  • Paleologos, Nina A.
  • Ryken, Timothy C.
  • Burri, Stuart H.
  • Asher, Anthony L.
  • Loeffler, Jay S.
  • Robinson, Paula D.
  • Andrews, David W.
  • Gaspar, Laurie E.
  • Kondziolka, Douglas
  • McDermott, Michael
  • Mehta, Minesh P.
  • Mikkelsen, Tom
  • Olson, Jeffrey J.
  • Patchell, Roy A.
  • Kalkanis, Steven N.
  • et al.
Abstract

What evidence is available regarding the use of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), surgical resection or chemotherapy for the treatment of recurrent/progressive brain metastases? Target population This recommendation applies to adults with recurrent/progressive brain metastases who have previously been treated with WBRT, surgical resection and/or radiosurgery. Recurrent/progressive brain metastases are defined as metastases that recur/progress anywhere in the brain (original and/or non-original sites) after initial therapy. Recommendation Level 3 Since there is insufficient evidence to make definitive treatment recommendations in patients with recurrent/progressive brain metastases, treatment should be individualized based on a patient’s functional status, extent of disease, volume/number of metastases, recurrence or progression at original versus non-original site, previous treatment and type of primary cancer, and enrollment in clinical trials is encouraged. In this context, the following can be recommended depending on a patient’s specific condition: no further treatment (supportive care), re-irradiation (either WBRT and/or SRS), surgical excision or, to a lesser extent, chemotherapy. Question If WBRT is used in the setting of recurrent/progressive brain metastases, what impact does tumor histopathology have on treatment outcomes? No studies were identified that met the eligibility criteria for this question.

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