CNS Updates Guidelines on Brain Metastases – Emerging therapies, highlighting evidence and linking to recommendations for LITT
Schaumburg, Ill., April 9, 2025—The Congress of Neurological Surgeons (CNS) has published new guidelines in Neurosurgery, the official publication of CNS, regarding the use of emerging therapies for the treatment of metastatic brain tumors. Updating recommendations from the 2019 CNS Guidelines regarding the use of emerging therapies for adult patients with metastatic brain tumors, this systematic review provides evidence-based recommendations for adult patients with metastatic brain tumors related to targeted therapy and immunotherapy, laser interstitial thermal therapy (LITT) and radiosensitizers, interstitial modalities and high intensity focused ultrasound (HIFU).
LITT is becoming an increasingly utilized tool for the treatment of many neurological conditions. Specific to this guideline, at the time the systematic review was conducted, the qualifying literature for the use of LITT in the management of BMs was limited. Two Class III studies demonstrated “relative equality of LITT and craniotomy for tumor management and LITT and medical management for radiation necrosis based on similar progression-free survival and overall survival in both settings.” Both studies emphasized their “limitations and that physicians need to carefully consider all clinical factors and individualize interventions.” These retrospective studies were well conducted and warrant “serious consideration” when treating patients with brain metastases as outlined in the published guideline.
Dr. Jeff Olson, task force chair states “compared to the 2019 version of the guidelines on the management of brain metastases, this update document reflects the substantial increase in the knowledge regarding the therapy of metastatic brain tumors across a number of treatment modalities. Familiarity with it will allow neurosurgeons to communicate more effectively with medical and radiation oncologists on modalities beyond standard surgery, ideally to optimize multi-modality care of individuals with this disease.”
CNS will perform another planned update of the entire Brain Metastases guideline in 2026 to continue to maintain currency and accuracy of these essential clinical practice guidelines.
CNS is committed to maintaining the infrastructure to develop and disseminate high quality clinical practice guidelines to help clinicians confront a rapidly changing healthcare environment and improve patient outcomes.
Disclosure of Funding
These evidence-based clinical practice guidelines were funded exclusively by the Congress of Neurological Surgeons and the Joint Section on Tumors, which received no funding from outside commercial sources to support the development of this document.
Disclaimer of Liability
This clinical systematic review and evidence-based guideline was developed by a physician volunteer task force as an educational tool that reflects the current state of knowledge at the time of completion. Each chapter is designed to provide an accurate review of the subject matter covered. This guideline is disseminated with the understanding that the recommendations by the authors and consultants who have collaborated in their development are not meant to replace the individualized care and treatment advice from a patient's physician(s). If medical advice or assistance is required, the services of a competent physician should be sought. The proposals contained in these guidelines may not be suitable for use in all circumstances. The choice to implement any particular recommendation contained in these guidelines must be made by a managing physician in light of the situation in each particular patient and on the basis of existing resources.
All information in the guideline and press release is subject to @Congress of Neurological Surgeons.
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About the Congress of Neurological Surgeons
The Congress of Neurological Surgeons (CNS) is the global leader in neurosurgical education, serving to promote health by advancing neurosurgery through innovation and excellence in education. The CNS provides leadership in neurosurgery by inspiring and facilitating scientific discoveries and its translation into clinical practice. The CNS maintains the vitality of the profession through the volunteer efforts of its members and the development of leadership in service to the public, to colleagues in other disciplines, and to neurosurgeons throughout the world in all stages of their professional lives. For more information, visit cns.org.