University of Virginia Medical Center, Charlottesville, VA.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2022 Jul 10;40(20):2271-2276. doi: 10.1200/JCO.22.00333. Epub 2022 May 13.
American Society of Radiation Oncology (ASTRO) has developed a guideline on appropriate radiation therapy for brain metastases. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.
"Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline" was reviewed for developmental rigor by methodologists. An ASCO Endorsement Panel subsequently reviewed the content and the recommendations.
The ASCO Endorsement Panel determined that the recommendations from the ASTRO guideline, published May 6, 2022, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorses "Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline.".
Within the guideline, stereotactic radiosurgery (SRS) is recommended for patients with Eastern Cooperative Oncology Group performance status of 0-2 and up to four intact brain metastases, and conditionally recommended for patients with up to 10 intact brain metastases. The guideline provides detailed dosing and fractionation recommendations on the basis of the size of the metastases. For patients with resected brain metastases, radiation therapy (SRS or whole-brain radiation therapy [WBRT]) is recommended to improve intracranial disease control; if there are limited additional brain metastases, SRS is recommended over WBRT. For patients with favorable prognosis and brain metastases ineligible for surgery and/or SRS, WBRT is recommended with hippocampal avoidance where possible and the addition of memantine is recommended. For patients with brain metastases, limiting the single-fraction V to brain tissue to ≤ 10 cm is conditionally recommended.Additional information is available at www.asco.org/neurooncology-guidelines.
美国放射肿瘤学会（ASTRO）制定了脑转移瘤放疗的指南。ASCO 有一项政策和程序，用于认可由其他专业组织制定的临床实践指南。
方法学家对“脑转移瘤放疗：ASTRO 临床实践指南”进行了发展严谨性审查。随后，ASCO 认可小组审查了内容和建议。
ASCO 认可小组确定，ASTRO 指南于 2022 年 5 月 6 日发布的建议明确、全面，并基于最相关的科学证据。ASCO 认可“脑转移瘤放疗：ASTRO 临床实践指南”。
在该指南中，立体定向放射外科（SRS）推荐用于东部合作肿瘤学组（ECOG）表现状态为 0-2 级且不超过 4 个完整脑转移瘤的患者，有条件推荐用于不超过 10 个完整脑转移瘤的患者。该指南根据转移瘤的大小提供了详细的剂量和分割建议。对于接受过脑转移瘤切除术的患者，推荐放疗（SRS 或全脑放疗 [WBRT]）以改善颅内疾病控制；如果有有限的其他脑转移，建议 SRS 优于 WBRT。对于预后良好且不符合手术和/或 SRS 条件的脑转移瘤患者，建议行 WBRT，如有可能，建议行海马回避，并建议加用美金刚。对于脑转移瘤患者，建议有条件地将单次分割 V 至脑组织的剂量限制为≤10cm。更多信息可在 www.asco.org/neurooncology-guidelines 上获取。
