metastatic cancer

Updated Guideline on Radiation Therapy for Brain Metastases

The American Society for Radiation Oncology (ASTRO) have updated their radiation therapy recommendations to address 4 key questions on the management of intact and resected brain metastases from nonhematologic solid tumors.

The updated guidelines address recent developments including the emergence of systemic therapies with central nervous system activity.

For patients with asymptomatic brain metastases who are eligible for active systemic therapy administered to the central nervous system, the task force conditionally recommends multidisciplinary and patient-centered decision-making to decide whether local therapy may be safely deferred. For all tumors that are causing a mass effect, that are larger than 4 cm, or both, they conditionally recommend a multidisciplinary discussion with neurosurgery to consider surgical resection.

The task force strongly recommend stereotactic radiosurgery for patients with limited brain metastases who have an Eastern Cooperative Oncology Group performance scale score of 0 to 2. They also recommended stereotactic radiosurgery to improve local control in patients with resected brain metastases.

In addition, they strongly recommend upfront local therapy for patients with symptomatic brain metastases and avoiding the hippocampus and memantine for patients with brain metastases who are receiving whole brain radiation therapy and have a favorable prognosis. In contrast, for patients with poor prognosis, they recommend early introduction of palliative care for symptom management and caregiver support.

“The task force has proposed recommendations to inform best clinical practices on the use of radiation therapy for brain metastases with strong emphasis on multidisciplinary care,” they concluded.


—Ellen Kurek



Gondi V, Bauman G, Bradfield L, et al. Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline. Practical Rad Oncol. Published online May 6, 2022. doi:10.1016/j.prro.2022.02.003