Brain metastases guidelines [Neurosurgery Wiki]

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====== Brain metastases guidelines ======

===== Latest PubMed-Related Articles for Brain metastases guidelines =====

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The **[[EANO]]–[[ESMO]] [[Clinical Practice Guideline]]s (2021)** provide comprehensive [[recommendation]]s for the [[diagnosis]], [[brain metastases treatment]], and follow-up of patients with brain metastases (BMs) originating from [[solid tumor]]s. These guidelines are a collaborative effort between the European Association of Neuro-Oncology ([[EANO]]) and the European Society for Medical Oncology ([[ESMO]]).

===== Brain metastases treatment guidelines =====
[[Brain metastases treatment guidelines]].


===== 🧠 Diagnosis =====

* **Neuroimaging**: Magnetic Resonance Imaging (MRI) with contrast is the preferred modality for detecting BMs. Recommended sequences include pre- and post-contrast T1-weighted, T2-weighted, T2-FLAIR, and diffusion-weighted imaging.

* **Screening**: Routine brain imaging is advised for patients with certain high-risk cancers, such as:

  * Stage IV melanoma

  * Metastatic HER2-positive or triple-negative breast cancer

  * Non-small-cell lung cancer (NSCLC), excluding stage I


===== 🩺 Treatment Recommendations =====

* **Surgery**: Considered for patients with a single brain metastasis or multiple resectable lesions, especially if they present with significant mass effect or require histological diagnosis.

* **[[Stereotactic Radiosurgery]] (SRS)**:

  * Recommended for patients with 1–4 brain metastases.
  * May be considered for those with 5–10 metastases, provided the cumulative tumor volume is less than 15 mL.

* **Whole-Brain Radiotherapy (WBRT)**: Reserved for patients with multiple brain metastases not amenable to SRS or surgery.

* **Systemic Therapy**:

  * Treatment should be tailored based on the histological and molecular characteristics of the primary tumor.
  * When feasible, molecular profiling of the brain metastasis itself is recommended to guide targeted therapies.([reference.medscape.com][3])

===== 🔄 Follow-Up =====


* **Imaging**: Regular MRI scans are essential to monitor treatment response and detect disease progression.

* **[[Multidisciplinar]]y Approach**: Optimal management involves collaboration among neuro-oncologists, medical oncologists, radiation oncologists, neurosurgeons, and other specialists.

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For detailed information, you can access the full guidelines here:
👉 [EANO–ESMO Clinical Practice Guidelines for Brain Metastases](https://www.eano.eu/publications/eano-guidelines/eano-esmo-clinical-practice-guidelines-for-diagnosis-treatment-and-follow-up-of-patients-with-brain-metastasis-from-solid-tumours/)



[1]: https://link.springer.com/article/10.1007/s00259-024-07038-5?utm_source=chatgpt.com "Joint EANM/EANO/RANO/SNMMI practice guideline/procedure standard for ..."
[2]: https://btrt.org/DOIx.php?id=10.14791%2Fbtrt.2023.0049&utm_source=chatgpt.com "Clinical Practice Guidelines for Brain Metastasis From Solid Tumors"
[3]: https://reference.medscape.com/viewarticle/963816?utm_source=chatgpt.com "Brain Metastasis Clinical Practice Guidelines (EANO/ESMO, 2021)"