Table 4.

Recommendations regarding treatment of recurrent brain metastasis

• Surgery can be an option in selected patients with favorable prognostic factors (younger age, high performance status, controlled systemic disease) and accessible location or when a differential diagnosis between tumor regrowth and radionecrosis (especially following SRS) is required (level C).

• Salvage SRS following initial WBRT can be an option in terms of local tumor control and survival (level C).

• Multiple courses of SRS for new brain metastases after an initial course of SRS can represent an alternative to WBRT (level C).