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


METHODS
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.


CONCLUSIONS
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.
Ammirati
Mario
M
Department of Neurosurgery, Ohio State University Medical Center, Columbus, OH, USA.
Cobbs
Charles S
CS
Linskey
Mark E
ME
Paleologos
Nina A
NA
Ryken
Timothy C
TC
Burri
Stuart H
SH
Asher
Anthony L
AL
Loeffler
Jay S
JS
Robinson
Paula D
PD
Andrews
David W
DW
Gaspar
Laurie E
LE
Kondziolka
Douglas
D
McDermott
Michael
M
Mehta
Minesh P
MP
Mikkelsen
Tom
T
Olson
Jeffrey J
JJ
Patchell
Roy A
RA
Kalkanis
Steven N
SN
D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D018450:Disease Progression; D019317:Evidence-Based Medicine; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000556:secondary / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016634:Radiosurgery / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016896:Treatment Outcome