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More common than primary brain tumors, which originate in the brain, brain metastases occur when cancerous cells break away from primary tumors in distant tissues or organs, then travel to the brain via the bloodstream or lymphatic system. While any type of cancer can potentially spread to the brain, the cancers most commonly associated with brain metastases initially develop in the lungbreast, skin (melanoma), colon, or kidney.

Studies show that approximately one-third of patients with another type of cancer will develop brain metastases. The site of primary cancer is often difficult to determine. For instance, the primary site may be too small to cause symptoms or show up in tests. The risk for metastatic brain tumors begins to increase after age 45 and is highest after age 65.

In 2021, the American Society of Clinical Oncology (ASCO), the Society for Neuro-Oncology (SNO) and the American Society for Radiation Oncology (ASTRO) developed the guideline that addresses the treatment of brain metastases from solid tumors. A multidisciplinary panel of experts in neurosurgery, neurology, neuro-oncology, medical oncology and radiation oncology collaborated in a highly-structured guideline development process.

The Journal of Clinical Oncology (JCO) published the "Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline" co-authored by Moffitt's Program Leader of Neuro-Oncology and Chief of Neurosurgery Dr. Michael Vogelbaum. The following is a summary of the guideline for the treatment of brain metastasis. 


  • What are the benefits and harms of surgery in adult patients with brain metastases?
  • What are the benefits and harms of laser interstitial thermal therapy?

Systemic therapy

  • What systemic therapy (chemotherapy, immunotherapy, and targeted agents) options, alone or in combination, have demonstrated clinical benefits in adults with brain metastases?

Radiation therapy

  • What are the benefits and harms of whole-brain radiation therapy (WBRT) in adults with brain metastases?
  • What approaches have been found to mitigate the harms of WBRT (e.g., radioprotectants, memantine, and hippocampal avoidance)?
  • What are the benefits and harms of stereotactic radiosurgery (SRS) or radiation therapy in adults with brain metastases?
  • What are the relative benefits and harms of SRS or radiation therapy compared to WBRT?
  • What are the benefits and harms of using radiation sensitizers?

Timing and interaction of therapy

  • How does the relative timing of surgery, radiation therapy, and systemic therapy affect the benefits and/or harms of those therapies?

"[This guideline] reinforces the need to have an experienced, multidisciplinary team to optimize the use of the latest types of immunotherapies and targeted agents with the more established treatments such as surgery and focused radiation therapy," said Dr. Vogelbaum.

For a complete set of expert guidelines from the Journal of Clinical Oncology’s article on surgery, systemic therapy, radiation therapy, and other recommendations for brain metastasis, please click here.

Moffitt Cancer Center is a well-established leader of brain cancer treatment, research and supportive care. We take a team approach that leverages the combined expertise of our neurosurgeons, medical oncologists, radiation oncologists, neuroradiologists, and other experts who focus exclusively on brain tumors. Because we are a high-volume cancer center, our brain cancer treatment team has acquired an unparalleled level of experience in addressing even the most complex brain metastases. In recognition of our extensive research and steadfast commitment to advancing brain cancer treatment, the National Cancer Institute has designated Moffitt as a Comprehensive Cancer Center, and we are the only such center based in Florida. 

If you’d like to refer a patient to Moffitt Cancer Center, complete our online form or contact a physician liaison for assistance. As part of our efforts to shorten referral times as much as possible, online referrals are typically responded to within 24 - 48 hours. 

Source: Journal of Clinical Oncology®, Treatment for Brain Metastasis: ASCO-SNO-ASTRO Guideline.