Cerebral metastases
Which cancers spread to the brain, MRI features, dexamethasone and seizure rules, the GPA score, radiosurgery versus whole-brain radiotherapy and the trials behind the shift, surgery, brain-penetrant systemic therapy, leptomeningeal disease and driving.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Brain metastases are the commonest intracranial tumour in adults, occurring in up to a fifth of people with cancer. Better imaging and longer survival on systemic therapy are increasing them.
- Lung, breast (especially HER2-positive and triple negative) and melanoma cause most.
- Treatment has moved toward stereotactic radiosurgery (SRS) and brain-penetrant systemic therapy. Whole-brain radiotherapy (WBRT) is used less because it harms cognition without improving survival.
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Sources
- Therapeutic Guidelines: Oncology and Palliative Care (brain metastases, raised intracranial pressure)AU/NZTherapeutic Guidelines Ltd
- eviQ Cancer Treatments Online (radiation oncology, CNS metastases)AU/NZCancer Institute NSW
- Assessing Fitness to Drive for commercial and private vehicle driversAU/NZAustroads and the National Transport Commission
- Le Rhun E et al. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours. Ann Oncol 2021;32(11):1332-47European Association of Neuro-Oncology and European Society for Medical Oncology, 2021 (no newer version found, November 2026)
- Vogelbaum MA et al. Treatment for brain metastases: ASCO-SNO-ASTRO guideline. J Clin Oncol 2022;40(5):492-516American Society of Clinical Oncology, Society for Neuro-Oncology, American Society for Radiation Oncology, 2022
- Brown PD et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases (N0574). JAMA 2016;316:401-9JAMA, 2016
- Yamamoto M et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901). Lancet Oncol 2014;15:387-95Lancet Oncology, 2014
- Brown PD et al. Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases (NRG CC001). J Clin Oncol 2020;38:1019-29Journal of Clinical Oncology, 2020
- Mulvenna P et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ). Lancet 2016;388:2004-14The Lancet, 2016
- Long GV et al. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases (ABC). Lancet Oncol 2018;19:672-81Lancet Oncology, 2018
- Sperduto PW et al. Survival in patients with brain metastases: summary report on the updated diagnosis-specific graded prognostic assessment. J Clin Oncol 2020;38:3773-84Journal of Clinical Oncology, 2020
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy