Overview
Metastatic malignant glioma refers to the spread of a primary brain tumor originating from glial cells to other parts of the brain or central nervous system. These tumors present complex palliative care needs due to their life-limiting nature and potential for neurological deterioration 3.Diagnosis
No information on diagnosis was provided in the abstracts.Management
Surgery is a reasonable option for patients with brain metastases, particularly for large tumors with mass effect 1.
Multidisciplinary discussion with neurosurgery is conditionally recommended to consider surgical resection for tumors causing mass effect and/or greater than 4 cm 2.
For symptomatic brain metastases, upfront local therapy is strongly recommended regardless of systemic therapy 12.
For asymptomatic brain metastases, local therapy should not be deferred unless specifically recommended, based on a multidisciplinary discussion of potential benefits and harms 1.
For asymptomatic brain metastases without systemic therapy options, stereotactic radiosurgery (SRS) alone is recommended for patients with one to four unresected brain metastases (excluding small-cell lung carcinoma) 1.
SRS alone to the surgical cavity is recommended for patients with one to two resected brain metastases 1.
SRS, whole brain radiation therapy, or their combination are reasonable options for asymptomatic brain metastases 1.
Palliative care should be integrated early for patients with glioma to reduce symptom burden and improve quality of life 3.Special Populations
No information on special populations was provided in the abstracts.Key Recommendations
For patients with limited brain metastases and Eastern Cooperative Oncology Group performance status 0 to 2, SRS is strongly recommended 2. (Evidence: Strong)
For patients with symptomatic brain metastases, upfront local therapy is strongly recommended 2. (Evidence: Strong)
Multidisciplinary discussion with neurosurgery is conditionally recommended to consider surgical resection for all tumors causing mass effect and/or that are greater than 4 cm 2. (Evidence: Moderate)
For patients with asymptomatic brain metastases eligible for central nervous system-active systemic therapy, multidisciplinary and patient-centered decision-making is recommended to determine if local therapy may be safely deferred 2. (Evidence: Moderate)
Surgery is a reasonable option for patients with brain metastases 1. (Evidence: Moderate)
Palliative care should be initiated early for adult patients with glioma to address complex needs and improve quality of life 3. (Evidence: Expert opinion)References
1 Vogelbaum MA, Brown PD, Messersmith H, Brastianos PK, Burri S, Cahill D et al.. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2022. link
2 Gondi V, Bauman G, Bradfield L, Burri SH, Cabrera AR, Cunningham DA et al.. Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline. Practical radiation oncology 2022. link
3 Pace A, Dirven L, Koekkoek JAF, Golla H, Fleming J, Rudà R et al.. European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma. The Lancet. Oncology 2017. link30345-5)