A multidisciplinary management algorithm for brain metastases
Alexander Ramos, Alexandra Giantini-Larsen, Susan C. Pannullo, Andrew Brandmaier, Jonathan Knisely, Rajiv Magge, Jessica Wilcox, Anna C. Pavlick, Barbara Ma, David J. Pisapia, Hani Ashamalla, Rohan Ramakrishna
Abstract
The incidence of brain metastases continues to present a management issue despite the advent of improved systemic control and overall survival. While the management of oligometastatic disease (ie, 1-4 brain metastases) with surgery and radiation has become fairly straightforward in the era of radiosurgery, the management of patients with multiple metastatic brain lesions can be challenging. Here we review the available evidence and provide a multidisciplinary management algorithm for brain metastases that incorporates the latest advances in surgery, radiation therapy, and systemic therapy while taking into account the latest in precision medicine-guided therapies. In particular, we argue that whole-brain radiation therapy can likely be omitted in most patients as up-front therapy.