Abstract
Management of brain metastases is challenging, both because of the historically guarded prognosis and evolving, more efficacious treatment paradigms for metastatic cancer. This perspective addresses several of the important difficult questions that practitioners treating patients with brain tumors face in the clinic. Successfully answering these questions requires knowledge of the clinical evidence, thoughtful discussion of the patient’s goals of care and collaboration in a multi-disciplinary setting.
Highlights
As the articles in this special issue illustrate, the management of brain metastases has changed and continues to evolve
We share our perspective on some of the most common and important questions we encounter in the clinical management of brain metastases
A collegial effort on the part of the “village” - medical oncologists, radiation oncologists, surgeons, palliative care specialists, navigators and nurses - centered on addressing the patient’s needs and based on evidence, will provide the best care and superior outcome for the patient presenting with brain metastases
Summary
As the articles in this special issue illustrate, the management of brain metastases has changed and continues to evolve. The need to balance toxicity with efficacy of treatment suggests that these patients may be best served by HF-SRS, as discussed above, rather than WBRT with its increased risk of neurocognitive deficits and prolonged recovery time or single-fraction SRS with greater risk of adverse-radiation effects at efficacious doses. Robust, written and rigorous quality assurance procedures for every element of the process that ensures that every element of the system is correct during each and every procedure If these requirements cannot be met locally, an alternative approach should be considered, including referral to a radiosurgery center, use of conventional radiotherapy and/or systemic treatment with proven efficacy in treating brain metastases, as appropriate
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