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The panel developed three key questions to guide systematic review: can radiotherapy be deferred in patients receiving EGFR or ALK TKIs at (1) diagnosis or (2) recurrence? Should TKI be administered concurrently with RT (3)? Two literature searches were performed (May 2019 and December 2023). The panel developed 8 model cases and voted on treatment options using a 9-point scale, with 1\u20133, 4\u20136 and 7\u20139 corresponding to usually not appropriate, may be appropriate, and usually appropriate (respectively), per the UCLA\/RAND Appropriateness Method. Consensus was achieved in only 4 treatment scenarios, all consistent with existing ARS-AUC guidelines for multiple BrM. The panel did not reach consensus that RT can be appropriately deferred in patients with BrM receiving CNS penetrant ALK or EGFR TKIs, though median scores indicated deferral may be appropriate under most circumstances. Whole brain RT with concurrent TKI generated broad disagreement except in cases with 2\u20134 BrM, where it was considered usually not appropriate. We identified no definitive studies dictating optimal sequencing of TKIs and RT for EGFRm and ALK+ BrM. Until such studies are completed, the committee hopes these cases guide decision- making in this complex clinical space.<\/jats:p>","DOI":"10.1093\/neuonc\/noae041","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T08:12:24Z","timestamp":1709885544000},"page":"1195-1212","source":"Crossref","is-referenced-by-count":8,"title":["Executive summary of the American Radium Society appropriate use criteria for brain metastases in epidermal growth factor receptor mutated-mutated and ALK-fusion non-small cell lung cancer"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0289-2319","authenticated-orcid":false,"given":"Seema","family":"Nagpal","sequence":"first","affiliation":[{"name":"Department of Neurology, Stanford University , Palo Alto, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8676-2855","authenticated-orcid":false,"given":"Michael 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