Treatment of CNS Metastases with More Than 10 Brain Lesions and Uncontrolled Extracranial Disease

This protocol addresses a challenging presentation: patients with central nervous system metastases who have more than 10 brain metastases, concurrent uncontrolled disease outside the central nervous system, and lesions that are not suitable for stereotactic radiosurgery (SRS).

Clinical Scenario

The defining features of this population are a high brain lesion burden (>10 metastases), active extracranial disease, and a distribution or number of lesions that places them outside the criteria for SRS. Neurological symptoms, lesion size, and the number and location of metastases all factor into treatment selection in this setting.

Treatment Approach (Partial Overview)

Whole-brain radiation therapy is among the approaches evaluated in this setting, alongside surgical options for select lesion characteristics. The full decision pathway — including criteria for each modality, sequencing, and case-by-case considerations — is detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

WBRT should be considered for treatment of multiple BMs not amenable to SRS, depending on the presence of neurological symptoms, size, number and location of BMs and the choice and availability of CNS-active systemic therapy.

On an individual case-by-case consideration, surgery, (repeat) SRS, change of systemic treatment and combinations thereof may be considered.

DOI: 10.1016/j.annonc.2021.07.016

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