The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.

Authors

Minesh P Mehta, University of Wisconsin School of Public Health and MedicineFollow
Nina A Paleologos, Northshore University Health System, Evanston, ILFollow
Tom Mikkelsen, Henry Ford Health System, Detroit, MIFollow
Paula D Robinson, McMaster University Evidence-based Practice Center, Hamilton, ONFollow
Mario Ammirati, Ohio State University Medical CenterFollow
David W Andrews, Thomas Jefferson UniversityFollow
Anthony L Asher, Carolina Neurosurgery and Spine Associates, Charlotte, NCFollow
Stuart H Burri, Carolinas Medical Center, Charlotte, NCFollow
Charles S Cobbs, California Pacific Medical Center, San Francisco, CAFollow
Laurie E Gaspar, University of Colorado-Denver, Denver, COFollow
Douglas Kondziolka, University of Pittsburgh Medical Center, Pittsburgh, PAFollow
Mark E Linskey, University of California-Irvine Medical Center, Orange, CAFollow
Jay S Loeffler, Massachusetts General Hospital, Boston, MAFollow
Michael McDermott, University of California San Francisco, San Francisco, CAFollow
Jeffrey J Olson, Emory University School of Medicine, Atlanta, GAFollow
Roy A Patchell, Barrow Neurological Institute, Phoenix, AZFollow
Timothy C Ryken, Iowa Spine and Brain Institute, Iowa City, IAFollow
Steven N Kalkanis, Hermelin Brain Tumor Center, Henry Ford Health System, 2799 West Grand Blvd, K-11, Detroit, MIFollow

Document Type

Article

Publication Date

1-1-2010

Comments

This article has been peer reviewed. It was published in: Journal of neuro-oncology.

Volume 96, Issue 1, Jan 2010, Pages 71-83.

The published version is available at DOI: 10.1007/s11060-009-0062-7 Copyright © Springer.

Abstract

TARGET POPULATION: This recommendation applies to adults with newly diagnosed brain metastases; however, the recommendation below does not apply to the exquisitely chemosensitive tumors, such as germinomas metastatic to the brain.

RECOMMENDATION: Should patients with brain metastases receive chemotherapy in addition to whole brain radiotherapy (WBRT)? Level 1 Routine use of chemotherapy following WBRT for brain metastases has not been shown to increase survival and is not recommended. Four class I studies examined the role of carboplatin, chloroethylnitrosoureas, tegafur and temozolomide, and all resulted in no survival benefit. Two caveats are provided in order to allow the treating physician to individualize decision-making: First, the majority of the data are limited to non small cell lung (NSCLC) and breast cancer; therefore, in other tumor histologies, the possibility of clinical benefit cannot be absolutely ruled out. Second, the addition of chemotherapy to WBRT improved response rates in some, but not all trials; response rate was not the primary endpoint in most of these trials and end-point assessment was non-centralized, non-blinded, and post-hoc. Enrollment in chemotherapy-related clinical trials is encouraged.

Recommended Citation

Mehta, Minesh P; Paleologos, Nina A; Mikkelsen, Tom; Robinson, Paula D; Ammirati, Mario; Andrews, David W; Asher, Anthony L; Burri, Stuart H; Cobbs, Charles S; Gaspar, Laurie E; Kondziolka, Douglas; Linskey, Mark E; Loeffler, Jay S; McDermott, Michael; Olson, Jeffrey J; Patchell, Roy A; Ryken, Timothy C; and Kalkanis, Steven N, "The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline." (2010). Department of Neurosurgery Faculty Papers. Paper 28.
https://jdc.jefferson.edu/neurosurgeryfp/28

PubMed ID

19960229