Table 4 Selected guidelines for treatment of brain metastases
Guideline | Ref. | Published | NSCLC specific | Important recommendations and messages |
|---|---|---|---|---|
EANO | [31] | 2017 | No, but contains a NSCLC section with main focus on systemic therapy | The decision regarding whether to employ SRS, SFRT, WBRT, alone or in combination, for patients with multiple brain metastases comes down to clinical discretion, patient preference and logistical considerations with the absolute number of brain metastases becoming less crucial WBRT or best supportive care should be considered for patients with short life expectancy (low KPS score and/or progressive systemic disease) |
UK NICE | [32] | 2018 | No | Consider maximal local therapy with either surgery, SRS or SFRT for people with a single brain metastasis Consider SRS/SFRT for people with multiple brain metastases who have controlled or controllable extracranial disease and KPS of 70 or more; take into account the number and total volume of metastases Do not offer WBRT to people with NSCLC and brain metastases that are not suitable for surgery or SRS/SFRT and have a KPS of under 70 |
National Norwegian guideline | [33] | 2018 | Yes | SRS/SFRT should be considered for 1–4 brain metastases If ECOG PS 3–4 SC is recommended, if better PS and > 4 brain metastases WBRT is recommended (4 Gy × 5 or 3 Gy × 10) |
Princess Margaret Cancer Centre | [34] | 2018 | No | The standard of care for patients with brain metastases is currently in a state of flux WBRT is our usual recommendation for patients with > 4–6 brain metastases |