title: The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline.
abstract: 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.
authors: Department of Neurosurgery, Ohio State University Medical Center, Columbus, OH, USA.
authors: Mario
authors: M
authors: Ammirati
authors: Charles S
authors: CS
authors: Cobbs
authors: Mark E
authors: ME
authors: Linskey
authors: Nina A
authors: NA
authors: Paleologos
authors: Timothy C
authors: TC
authors: Ryken
authors: Stuart H
authors: SH
authors: Burri
authors: Anthony L
authors: AL
authors: Asher
authors: Jay S
authors: JS
authors: Loeffler
authors: Paula D
authors: PD
authors: Robinson
authors: David W
authors: DW
authors: Andrews
authors: Laurie E
authors: LE
authors: Gaspar
authors: Douglas
authors: D
authors: Kondziolka
authors: Michael
authors: M
authors: McDermott
authors: Minesh P
authors: MP
authors: Mehta
authors: Tom
authors: T
authors: Mikkelsen
authors: Jeffrey J
authors: JJ
authors: Olson
authors: Roy A
authors: RA
authors: Patchell
authors: Steven N
authors: SN
authors: Kalkanis
mesh_terms: 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