Clinical Scenario

Patients presenting with brain metastases — whether a single lesion or a limited number of lesions — where local interventional strategies are applicable. The protocol addresses both resectable disease and situations suited to radiation-based local therapy.

Treatment Approach

Management involves a combination of surgical and stereotactic radiation-based strategies, selected according to the number and characteristics of brain lesions. The sequencing of these modalities and the criteria that determine which approach applies are specified in the full protocol.

Complete regimen details, eligibility criteria, and the full clinical algorithm are available in the structured protocol below.

Treatment Goals

The primary objective is no progression or recurrence of brain metastases on neuroimaging, assessed at 3-monthly follow-up intervals.

References

DOI: 10.1016/j.annonc.2021.07.016

Single BMs should be considered for surgical resection.
Multiple resectable BMs may be considered for surgical resection.
SRS is recommended for patients with a limited number (1-4) of BMs.
SRS to the resection cavity is recommended after complete or incomplete resection of BMs.
It is commonly given as single fraction utilising doses between 15 and 24 Gy.
Fractionated SRS given in two to five fractions typically delivered with 27 Gy in three fractions or 30 Gy in five fractions is preferred in patients with larger lesions (>3 cm diameter) or lesions in proximity of structures at risk, e.g. the brain stem or in pre-irradiated patients.
Patients with a history of BM should be followed up by neurological assessment and neuroimaging in 3-monthly intervals and whenever clinically indicated.

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Treatment of Brain Metastases: Surgical Resection and Stereotactic Radiosurgery

Clinical Scenario

Treatment Approach

Treatment Goals

References