ARLINGTON, Va., May 10, 2022 — A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides guidance on the use of radiation therapy to treat patients with brain metastases. Evidence-based recommendations guide the multidisciplinary planning and delivery of advanced radiation therapy techniques to manage intact and resected brain metastases from non-hematologic solid tumors. The guideline, which updates ASTRO’s original 2012 guideline to reflect recent research developments, is published in Practical Radiation Oncology.

Brain metastases form when cancer cells spread to the brain from a primary tumor located elsewhere in the body, most commonly lung cancer, breast cancer or melanoma. Brain metastases are the most common type of brain tumors – roughly 10 times more common than primary brain tumors. They develop in 20-40% of people diagnosed with cancer, with approximately 200,000 new cases diagnosed in the U.S. each year.

Radiation therapy is commonly used to manage brain metastases, prolong survival and provide relief from headaches, dizziness and other neurological problems these tumors can cause. Whole-brain irradiation, however, is associated with cognitive deterioration. To reduce these adverse effects and preserve patients’ quality of life, researchers developed advanced radiation therapy techniques including stereotactic radiosurgery (SRS) and hippocampal avoidance whole brain radiation therapy (HA-WBRT) that result in fewer side effects. These treatments deliver therapeutic doses of radiation to the tumors while limiting exposure to healthy brain tissue.

“In the decade since the previous ASTRO brain metastases guideline, there has been a tremendous evolution in the way we manage patients’ disease. The development of stereotactic radiosurgery allowed treatment of limited brain metastases alone, often in a single fraction, while largely sparing the surrounding brain. Additionally, novel techniques such as hippocampal avoidance with whole-brain radiation can greatly improve our patients’ quality of life,” said Paul D. Brown, MD, chair of the guideline task force and a professor of radiation oncology at the Mayo Clinic in Rochester, Minnesota.

Recent developments to manage brain metastases also include advances in neurosurgical care as well as emerging systemic therapies that may serve as alternates or adjuncts to radiation therapy and surgery. Chemotherapy traditionally has not been a common treatment for brain metastases due to the impenetrability of the blood-brain barrier, but newer medicines such as targeted therapies and immunotherapy show potential to circumvent this hurdle.

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