Recurrent/Progressive Brain Metastases

The American Association of Neurological Surgeons & the Congress of Neurological Surgeons

What evidence is available regarding the use of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), surgical resection or chemotherapy for the treatment of recurrent/progressive brain metastases?

Target population

This recommendation applies to adults with recurrent/progressive brain metastases who
have previously been treated with WBRT, surgical resection and/or radiosurgery.
Recurrent/progressive brain metastases are defined as metastases that recur/progress
anywhere in the brain (original and/or non-original sites) after initial therapy.


Level 3 Since there is insufficient evidence to make definitive treatment
recommendations in patients with recurrent/progressive brain metastases, treatment
should be individualized based on a patient’s functional status, extent of disease,
volume/number of metastases, recurrence or progression at original versus non-original
site, previous treatment and type of primary cancer, and enrollment in clinical trials is
encouraged. In this context, the following can be recommended depending on a
patient’s specific condition: no further treatment (supportive care), re-irradiation (either
WBRT and/or SRS), surgical excision or, to a lesser extent, chemotherapy.

If WBRT is used in the setting of recurrent/progressive brain metastases, what impact does tumor histopathology have on treatment outcomes?

No studies were identified that met the eligibility criteria for this question.