The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline.

Authors

Mario Ammirati, Ohio State University Medical Center, Columbus, OHFollow
Charles S Cobbs, California Pacific Medical Center, San Francisco, CAFollow
Mark E Linskey, University of California-Irvine Medical Center, Orange, CAFollow
Nina A Paleologos, Northshore University Health System, Evanston, ILFollow
Timothy C Ryken, Iowa Spine and Brain Institute, Iowa City, IAFollow
Stuart H Burri, Carolinas Medical Center, Charlotte, NCFollow
Anthony L Asher, Carolina Neurosurgery and Spine Associates, Charlotte, NCFollow
Jay S Loeffler, Massachusetts General Hospital, Boston, MAFollow
Paula D Robinson, McMaster University Evidence-Based Practice Center, Hamilton, ONFollow
David W Andrews, Thomas Jefferson UniversityFollow
Laurie E Gaspar, University of Colorado-Denver, Denver, COFollow
Douglas Kondziolka, University of Pittsburgh Medical Center, Pittsburgh, PAFollow
Michael McDermott, University of California San Francisco, San Francisco, CAFollow
Minesh P Mehta, University of Wisconsin School of Public Health and Medicine, Madison, WIFollow
Tom Mikkelsen, Henry Ford Health System, Detroit, MIFollow
Jeffrey J Olson, Emory University School of Medicine, Atlanta, GAFollow
Roy A Patchell, Barrow Neurological Institute, Phoenix, AZFollow
Steven N Kalkanis, 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, December 2009, Pages 85-96.

The published version is available at DOI: 10.1007/s11060-009-0055-6. Copyright © Springer

Abstract

QUESTION: What evidence is available regarding the use of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), surgical resection or chemotherapy for the treatment of recurrent/progressive brain metastases?

TARGET POPULATION: This recommendation applies to adults with recurrent/progressive brain metastases who have previously been treated with WBRT, surgical resection and/or radiosurgery. Recurrent/progressive brain metastases are defined as metastases that recur/progress anywhere in the brain (original and/or non-original sites) after initial therapy.

RECOMMENDATION: Level 3 Since there is insufficient evidence to make definitive treatment recommendations in patients with recurrent/progressive brain metastases, treatment should be individualized based on a patient's functional status, extent of disease, volume/number of metastases, recurrence or progression at original versus non-original site, previous treatment and type of primary cancer, and enrollment in clinical trials is encouraged. In this context, the following can be recommended depending on a patient's specific condition: no further treatment (supportive care), re-irradiation (either WBRT and/or SRS), surgical excision or, to a lesser extent, chemotherapy. Question If WBRT is used in the setting of recurrent/progressive brain metastases, what impact does tumor histopathology have on treatment outcomes? No studies were identified that met the eligibility criteria for this question.

Recommended Citation

Ammirati, Mario; Cobbs, Charles S; Linskey, Mark E; Paleologos, Nina A; Ryken, Timothy C; Burri, Stuart H; Asher, Anthony L; Loeffler, Jay S; Robinson, Paula D; Andrews, David W; Gaspar, Laurie E; Kondziolka, Douglas; McDermott, Michael; Mehta, Minesh P; Mikkelsen, Tom; Olson, Jeffrey J; Patchell, Roy A; and Kalkanis, Steven N, "The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline." (2010). Department of Neurosurgery Faculty Papers. Paper 40.
https://jdc.jefferson.edu/neurosurgeryfp/40

PubMed ID

19957016