Multidisciplinary management strategies for recurrent brain metastasis after prior radiotherapy: An overview

Rupesh Kotecha; Alonso La Rosa; Paul D Brown; Michael A Vogelbaum; Pierina Navarria; Raphael Bodensohn; Maximilian Niyazi; Philipp Karschnia; Giuseppe Minniti

doi:10.1093/neuonc/noae220

Multidisciplinary management strategies for recurrent brain metastasis after prior radiotherapy: An overview

Neuro Oncol. 2024 Nov 4:noae220. doi: 10.1093/neuonc/noae220. Online ahead of print.

Authors

Rupesh Kotecha^{1

2

3}, Alonso La Rosa^{1

4}, Paul D Brown⁵, Michael A Vogelbaum⁶, Pierina Navarria⁷, Raphael Bodensohn^{8

9}, Maximilian Niyazi^{8

9

10}, Philipp Karschnia^{11

12}, Giuseppe Minniti^{13

14}

Affiliations

¹ Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.
² Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
³ Department of Translational Medicine, Hebert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
⁴ Department of Radiation Oncology, Hospital Universitario La Paz, Madrid, Spain.
⁵ Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
⁷ Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano, Milan, Italy.
⁸ Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany.
⁹ Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany.
¹⁰ Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
¹¹ Department of Neurosurgery, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany.
¹² Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
¹³ Department of Radiological Sciences, Oncology, and Anatomical Pathology, Sapienza University of Rome, Rome, Italy.
¹⁴ IRCCS Neuromed, Pozzilli (IS), Italy.

PMID: 39495010
DOI: 10.1093/neuonc/noae220

Abstract

As cancer patients with intracranial metastatic disease experience increasingly prolonged survival, the diagnosis and management of recurrent brain metastasis pose significant challenges in clinical practice. Prior to deciding upon a management strategy, it is necessary to ascertain whether patients have recurrent/progressive disease vs adverse radiation effect, classify the recurrence as local or distant in the brain, evaluate the extent of intracranial disease (size, number and location of lesions, and brain metastasis velocity), the status of extracranial disease, and enumerate the interval from the last intracranially directed intervention to disease recurrence. A spectrum of salvage local treatment options includes surgery (resection and laser interstitial thermal therapy [LITT]) with or without adjuvant radiotherapy in the forms of external beam radiotherapy, intraoperative radiotherapy, or brachytherapy. Nonoperative salvage local treatments also range from single fraction and fractionated stereotactic radiosurgery (SRS/FSRS) to whole brain radiation therapy (WBRT). Optimal integration of systemic therapies, preferably with central nervous system (CNS) activity, may also require reinterrogation of brain metastasis tissue to identify actionable molecular alterations specific to intracranial progressive disease. Ultimately, the selection of the appropriate management approach necessitates a sophisticated understanding of patient, tumor, and prior treatment-related factors and is often multimodal; hence, interdisciplinary evaluation for such patients is indispensable.

Keywords: brain metastases; progression; radiosurgery; radiotherapy; recurrence.

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