American College of Radiology Appropriateness Criteria on Multiple Brain Metastases

Gregory M.M. Videtic, Laurie E. Gaspar, Amr M. Aref, Isabelle M. Germano, Brian J. Goldsmith, Joseph P. Imperato, Karen J. Marcus, Michael W. McDermott, Mark W. McDonald, Roy A. Patchell, H. Ian Robins, C. Leland Rogers, John H. Suh, Aaron H. Wolfson, Franz J. Wippold

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations


Whole-brain radiotherapy is an effective palliative treatment for patients with multiple brain metastases. Approximately half of these patients experience an improvement in their neurologic symptoms. However, a majority of them do not achieve local control and frequently die of progressive brain disease. Any perceived benefits from surgery need verification in prospective, randomized, Phase III clinical trials. The effectiveness of SRS for patients with multiple metastases may be primarily a function of proper patient selection, but it probably cannot replace the benefits of WBRT, as demonstrated in the Aoyama trial (34). Effective radiation sensitizers are needed because WBRT alone, even in doses of 5000-5440 cGy, has not been associated with an improved survival outcome. Future trials of WBRT must include prospective measurement of neurocognitive functioning before and after treatment as a standard component of the patient's assessment.

Original languageEnglish
Pages (from-to)961-965
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number4
StatePublished - 15 Nov 2009


  • Appropriateness criteria
  • Multiple brain metastases
  • Radiosurgery
  • Surgery
  • Whole-brain radiotherapy


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