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

Authors

Laurie E Gaspar, University of Colorado-DenverFollow
Minesh P Mehta, Universtity of Wisconsin School of Public Health and MedicineFollow
Roy A Patchell, Barrow Neurological Institute, Phoenix, AZFollow
Stuart H Burri, Carolinas Medical Center, Charlotte, NCFollow
Paula D Robinson, McMaster University Evidence-Based Practice Center, Hamilton, ONFollow
Rachel E Morris, McMaster University Evidence-Based Practice Center, Hamilton, ON
Mario Ammirati, Ohio State University Medical Center, Columbus, OHFollow
David W Andrews, Thomas Jefferson UniversityFollow
Anthony L Asher, Carolina Neurosurgery and Spine Associates, Charlotte, NCFollow
Charles S Cobbs, California Pacific Medical Center, San Francisco, CAFollow
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
Tom Mikkelsen, Henry Ford Health System, Detroit, MIFollow
Jeffrey J Olson, Emory University School of Medicine, Atlanta, GAFollow
Nina A Paleologos, Northshore University Health System, Evanston, ILFollow
Timothy C Ryken, Iowa Spine and Brain Institute, Iowa City, IAFollow
Steven N Kalkanis, Henry Ford Health System, Hermelin Brain Tumor Center, 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, December 2009, Pages 17-32.

The published version is available at DOI: 10.1007/s11060-009-0060-9. Copyright © Springer

Abstract

QUESTION: Should patients with newly-diagnosed metastatic brain tumors undergo open surgical resection versus whole brain radiation therapy (WBRT) and/or other treatment modalities such as radiosurgery, and in what clinical settings?

TARGET POPULATION: These recommendations apply to adults with a newly diagnosed single brain metastasis amenable to surgical resection.

RECOMMENDATIONS: Surgical resection plus WBRT versus surgical resection alone Level 1 Surgical resection followed by WBRT represents a superior treatment modality, in terms of improving tumor control at the original site of the metastasis and in the brain overall, when compared to surgical resection alone. Surgical resection plus WBRT versus SRS + or - WBRT Level 2 Surgical resection plus WBRT, versus stereotactic radiosurgery (SRS) plus WBRT, both represent effective treatment strategies, resulting in relatively equal survival rates. SRS has not been assessed from an evidence-based standpoint for larger lesions (>3 cm) or for those causing significant mass effect (>1 cm midline shift). Level 3 Underpowered class I evidence along with the preponderance of conflicting class II evidence suggests that SRS alone may provide equivalent functional and survival outcomes compared with resection + WBRT for patients with single brain metastases, so long as ready detection of distant site failure and salvage SRS are possible. Note The following question is fully addressed in the WBRT guideline paper within this series by Gaspar et al. Given that the recommendation resulting from the systematic review of the literature on this topic is also highly relevant to the discussion of the role of surgical resection in the management of brain metastases, this recommendation has been included below.

Recommended Citation

Gaspar, Laurie E; Mehta, Minesh P; Patchell, Roy A; Burri, Stuart H; Robinson, Paula D; Morris, Rachel E; Ammirati, Mario; Andrews, David W; Asher, Anthony L; Cobbs, Charles S; Kondziolka, Douglas; Linskey, Mark E; Loeffler, Jay S; McDermott, Michael; Mikkelsen, Tom; Olson, Jeffrey J; Paleologos, Nina A; Ryken, Timothy C; and Kalkanis, Steven N, "The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline." (2010). Department of Neurosurgery Faculty Papers. Paper 39.
https://jdc.jefferson.edu/neurosurgeryfp/39

PubMed ID

19960231