For patients with good prognosis (expected survival of 3 months or more), the number, size and resectability of metastases were identified as important factors to consider. The use of histology-specific indices was recommended to estimate prognosis. The ASTRO guidelines recommended using estimated prognosis and aims of treatment to guide management decisions. 10- 15 The American Society of Radiation Oncology (ASTRO) published guidelines for the radiotherapeutic and surgical management of brain metastases in 2012. Several guidelines for the management of brain metastases have been published. Finally, for some patients with a very poor prognosis, supportive care alone may be appropriate. Each of these treatment options may be considered alone or in combination. Systemic therapy includes chemotherapy and immunotherapy regimens. Surgery for brain metastases aims to remove the tumor. SRS is a treatment option that delivers precisely-targeted radiation to the brain metastases. WBRT is administered to the entire brain, typically over multiple treatments (although hippocampal-avoidance WBRT is more selective regarding the dose for different areas of the brain). Treatment options for brain metastases include whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), conventional surgery, and systemic therapies. 3 Primary tumors that most commonly metastasize to the brain are lung cancer (30–60% of all brain metastases), breast cancer (5–30% of brain metastases in women), and melanoma (5–21%) this systematic review will focus on these primary cancer types. 5- 8 Brain metastases occur with a variety of cancers, which may have different subtypes or molecular profiles that respond differently to treatment. 4 However, the patient population affected by brain metastases is heterogeneous, and recent studies have shown that prognosis can vary substantially. Historically, patients with brain metastases had a poor prognosis, and little thought was given to determining each individual's prognosis and optimal treatment. 2, 3 The development of brain metastases may have substantial prognostic implications by causing neurologic symptoms or death. 1 The apparent incidence of brain metastases is increasing as diagnostic tools are refined and advances in systemic therapy that improve survival may also be leading to an actual increase. The planned systematic review will determine the effects of radiation therapy to treat brain metastases.īrain metastases are a common problem in cancer care, occurring in 10 to 30 percent of adult patients. The management of brain metastases is challenging due to the effects of the disease and treatment on patients. The development of secondary malignant growths has particular implications when cancer metastasizes to the brain. Background and Objectives for the Systematic Review