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ASTRO Guideline on Radiation Therapy for Brain Metastases

Published: July/August 2022 (Web posted May 2022)

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This guideline replacement focuses on radiotherapeutic management of intact (i.e., unresected) and resected brain metastases from non-hematologic solid tumors. It provides guidance on the reasonable use of modern radiation therapy (RT) strategies, including single-fraction and fractionated (i.e., hypofractionated stereotactic radiosurgery [SRS]) SRS and hippocampal avoidance whole brain radiation therapy (HA-WBRT) and discusses clinical considerations in selecting the optimal RT strategy or in deferring RT in favor of best supportive care or close neuro-oncologic surveillance. It also includes guidance on emerging central nervous system (CNS)-active systemic therapies such as targeted therapies and immunotherapy as alternatives or adjuncts to RT; and more detailed tools to estimate patient survival such as the graded prognostic assessment.

Developed in collaboration with:

  • American Association of Neurological Surgeons/Congress of Neurological Surgeons
  • American Society of Clinical Oncology
  • Society for Neuro-Oncology

Endorsed by:

  • American Society of Clinical Oncology
  • Society for Neuro-Oncology
  • Canadian Association of Radiation Oncology 
  • European Society for Radiotherapy and Oncology
  • Royal Australian and New Zealand College of Radiologists


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