The Role of Chemotherapy

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

Should patients with brain metastases receive chemotherapy in addition to whole brain radiotherapy (WBRT)?

Target population

This recommendation applies to adults with newly diagnosed brain metastases;
however, the recommendation below does not apply to the exquisitely chemosensitive
tumors, such as germinomas metastatic to the brain.


Level 1 Routine use of chemotherapy following WBRT for brain metastases has not
been shown to increase survival and is not recommended. Four class I studies
examined the role of carboplatin, chloroethylnitrosoureas, tegafur and temozolomide,
and all resulted in no survival benefit. Two caveats are provided in order to allow the
treating physician to individualize decision-making: First, the majority of the data are
limited to non small cell lung (NSCLC) and breast cancer; therefore, in other tumor
histologies, the possibility of clinical benefit cannot be absolutely ruled out. Second, the
addition of chemotherapy to WBRT improved response rates in some, but not all trials;
response rate was not the primary endpoint in most of these trials and end-point
assessment was non-centralized, non-blinded, and post-hoc. Enrollment in
chemotherapy-related clinical trails is encouraged.