Lin and DeAngelis outlined recommendations for management of a patient with brain metastases. One decision is whether or not to administer whole brain radiation therapy. The authors are from Memorial Sloan Kettering Cancer Center in New York City.
Patient selection: brain metastases
Indications for whole brain radiation therapy:
(1) The patient has progressive disease with poor performance status and limited chemotherapy options.
(2) There a multiple brain metastases.
(3) The tumor is known to be sensitive to radiation therapy.
(4) Large brain metastasis (> 4 cm) not amenable to surgery or stereotactic radiosurgery.
(5) Salvage therapy following recurrent brain metastasis.
(6) Following surgical resection of a dominant brain metastasis with multiple smaller brain metastases left behind.
where:
• A large tumor that cannot be resected might shrink enough after therapy to make surgery possible.
Requirements:
(1) The patient has given informed consent.
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