EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force |
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| Authors: | R. Soffietti P. Cornu J. Y. Delattre R. Grant F. Graus W. Grisold J. Heimans J. Hildebrand P. Hoskin M. Kalljo P. Krauseneck C. Marosi T. Siegal C. Vecht |
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| Affiliation: | Department of Neurology and Oncology, San Giovanni Battista Hospital and University, Torino, Italy;;Department of Neurosurgery, Pitiè-Salpétrière and University, Paris;;Department of Neurology, Pitié-Salpétrière, Paris, France;;Department of Neurology, Western General Hospital and University, Edinburgh, UK;;Service of Neurology, Hospital Clinic, Villaroel, Barcelona Spain;;Department of Neurology, Kaiser-Franz-Josef Spital, Vienna, Austria;;Department of Neurology, Academisch Ziekenhuis V.U., Amsterdam, The Netherlands;;Consultant Neurologist, Brussels, Belgium;;Department of Radiotherapy, Mount Vernon Hospital and University, Northwood, Middlesex, UK;;Department of Neurology, University Hospital, Helsinki, Finland;;Neurologische Clinic, Bamberg, Germany;;Division Oncology, Vienna General Hospital and University, Vienna, Austria;;Neuro-Oncology Clinic, Hadassah Hebrew University, Jerusalem, Israel;;and Department of Neurology, Med Center Haaglanden, The Hague, The Netherlands |
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| Abstract: | The objectives have been to establish evidence-based guidelines and identify controversies regarding the management of patients with brain metastases. The collection of scientific data was obtained by consulting the Cochrane Library, bibliographic databases, overview papers and previous guidelines from scientific societies and organizations. A tissue diagnosis is necessary when the primary tumor is unknown or the aspect on computed tomography/magnetic resonance imaging is atypical. Dexamethasone is the corticosteroid of choice for cerebral edema. Anticonvulsants should not be prescribed prophylactically. Surgery should be considered in patients with up to three brain metastases, being effective in prolonging survival when the systemic disease is absent/controlled and the performance status is high. Stereotactic radiosurgery should be considered in patients with metastases of 3–3.5 cm of maximum diameter. Whole-brain radiotherapy (WBRT) after surgery or radiosurgery is debated: in case of absent/controlled systemic cancer and Karnofsky Performance score of 70 or more, one can either withhold initial WBRT or deliver early WBRT with conventional fractionation to avoid late neurotoxicity. WBRT alone is the treatment of choice for patients with single or multiple brain metastases not amenable to surgery or radiosurgery. Chemotherapy may be the initial treatment for patients with brain metastases from chemosensitive tumors. |
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| Keywords: | brain metastases diagnosis evidence-based guidelines treatment |
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