[Practice guideline 'Brain metastases' (revision)].
Improved survival of cancer patients results in an increase in the incidence of brain metastases. In addition, asymptomatic brain metastases are more often detected as a consequence of active screening. In patients with cancer and new neurological symptoms, MRI of the brain is indicated to assess the presence and number of brain metastases. Decisions concerning treatment of brain metastases should take place within a multidisciplinary team. Treatment is in the first instance focused on improvement or preservation of neurological functioning. The main treatment options for patients with brain metastases are whole brain radiotherapy, stereotactic radiosurgery/radiotherapy, and neurosurgical resection. The choice of treatment depends on the number and the location of the brain metastases, the general and neurological condition of the patient, the extent of extracranial tumour activity, and the expected results of treatment. The revised guideline supports the policy of whole brain radiotherapy not being the standard treatment following stereotactic radiosurgery or radiotherapy. In the case of complete resection, confirmed using early postoperative MRI, whole brain radiotherapy does not add to survival benefit, while patients may suffer from radiation-induced toxicity.
Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands. j.gijtenbeek@neuro.umcn.nl
J M M Anja
JM
Gijtenbeek
Vincent K Y
VK
Ho
M A A M Mart
MA
Heesters
F J Frank
FJ
Lagerwaard
Alexander
A
de Graeff
Willem
W
Boogerd
D001932:Brain Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000556:secondary*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009426:Netherlands; D019635:Neurosurgical Procedures; D017410:Practice Guidelines as Topic; D011878:Radiotherapy; D015996:Survival Rate; D016896:Treatment Outcome