David Schiff, MD @uvahealthnews @UVACancerCenter #BrainMetastases New Guidelines Treatment: Brain Metastases

Dr. Schiff is the Harrison Distinguished Professor of Neurology, Neurological Surgery, and Medicine. He is the co-director of the UVA Neuro-Oncology Center at UVA Health. His specialties include clinical trials for malignant brain tumors and the management of neurological complications of cancer and its therapies. He has led or co-led numerous NCI-funded brain tumor and pharmaceutical clinical trials.

 

Dr. Schiff serves on the NCI brain malignancy steering committee and chairs the ECOG-ACRIN brain tumor, working group. He also serves on several editorial boards, most notably as the associate editor of the journal, Neuro-Oncology. 

 

In this video, he speaks about the New Brain Cancer Guidelines Set to Improve Care, Increase Patient Survival. 

 

Summary –

 

Intention:

 

To give professionals advice on how to treat patients with brain metastases from solid tumors.

 

Methodologies:

 

ASCO convened an Expert Panel to perform a systematic literature review.

 

Outcomes:

 

The major evidence base is made up of 32 randomized trials that were published in 2008 or later and matched the qualifying criteria.

 

Guidelines:

 

For patients with brain metastases, surgery is a viable option. Patients with big tumors that have a mass impact are more likely to benefit than patients with multiple brain metastases and/or uncontrolled systemic illness. Regardless of the systemic medication utilized, patients with symptomatic brain metastases should undergo local therapy. Local therapy should not be delayed in patients with asymptomatic brain metastases unless it is specifically specified in this guideline. The choice to postpone local therapy should be based on a multidisciplinary consideration of the patient’s prospective advantages and risks. For non–small-cell lung cancer, breast cancer, and melanoma, several regimens were indicated. Stereotactic radiosurgery (SRS) alone should be administered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma, who have asymptomatic brain metastases and no systemic therapeutic choices. Patients with one to two resected brain metastases should be provided SRS alone to the surgical cavity. Other patients may benefit from SRS, whole-brain radiation therapy, or a combination of the two. Patients who receive whole-brain radiation therapy and have no hippocampal injuries and estimated survival of four months or longer should be administered memantine and hippocampal avoidance. Patients with asymptomatic brain metastases who have a Karnofsky Performance Status of 50 or 70 and no other treatment choices do not benefit from radiation therapy.