CNS carcinoma

This page has regimens and guidelines that are not specific to any one type of cancer. For disease-specific regimens and guidelines, please go to the following pages:

• Breast cancer, CNS metastases
• Non-small cell lung cancer, CNS metastases

Section editor
	Seema Nagpal, MD Stanford University Palo Alto, CA, USA LinkedIn

Last updated on 2024-07-23: 1 regimens on this page 1 variants on this page

Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

ASCO

• 2022: Schiff et al. Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline PubMed

ASCO/SNO/ASTRO

• 2021: Vogelbaum et al. Treatment for Brain Metastases PubMed

EANO/ESMO

• 2021: Le Rhun et al. EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours PubMed
• 2017: Le Rhun et al. EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours PubMed

ISRS

• 2022: Grishcuk et al. ISRS Technical Guidelines for Stereotactic Radiosurgery: Treatment of Small Brain Metastases (≤1 cm in Diameter) PubMed
• 2018: Chao et al. Stereotactic Radiosurgery in the Management of Limited (1-4) Brain Metasteses: Systematic Review and International Stereotactic Radiosurgery Society Practice Guideline PubMed

NCCN

• NCCN does not have guidelines at this granular level; please see NCCN Guidelines - Central Nervous System Cancers.

All lines of therapy

Whole brain irradiation

WBRT: Whole-Brain Radiation Therapy

Regimen

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Knisely et al. 2007 (RTOG 0118)	2002-2004	Phase 3 (C)	Thalidomide & WBRT	Did not meet primary endpoint of OS

Radiotherapy

• Whole-brain irradiation 250 cGy fractions x 15 (total dose: 3750 cGy)

One course

References

1. RTOG 0118: Knisely JP, Berkey B, Chakravarti A, Yung AW, Curran WJ Jr, Robins HI, Movsas B, Brachman DG, Henderson RH, Mehta MP. A phase III study of conventional radiation therapy plus thalidomide versus conventional radiation therapy for multiple brain metastases (RTOG 0118). Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):79-86. Epub 2007 Dec 31. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT00033254