The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline
- PMID: 19960227
- PMCID: PMC2808519
- DOI: 10.1007/s11060-009-0073-4
The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline
Erratum in
- J Neurooncol. 2010 Jan;96(1):69-70
Abstract
Should patients with newly-diagnosed metastatic brain tumors undergo stereotactic radiosurgery (SRS) compared with other treatment modalities? Target population These recommendations apply to adults with newly diagnosed solid brain metastases amenable to SRS; lesions amenable to SRS are typically defined as measuring less than 3 cm in maximum diameter and producing minimal (less than 1 cm of midline shift) mass effect. Recommendations SRS plus WBRT vs. WBRT alone Level 1 Single-dose SRS along with WBRT leads to significantly longer patient survival compared with WBRT alone for patients with single metastatic brain tumors who have a KPS > or = 70.Level 1 Single-dose SRS along with WBRT is superior in terms of local tumor control and maintaining functional status when compared to WBRT alone for patients with 1-4 metastatic brain tumors who have a KPS > or =70.Level 2 Single-dose SRS along with WBRT may lead to significantly longer patient survival than WBRT alone for patients with 2-3 metastatic brain tumors.Level 3 There is class III evidence demonstrating that single-dose SRS along with WBRT is superior to WBRT alone for improving patient survival for patients with single or multiple brain metastases and a KPS<70 [corrected].Level 4 There is class III evidence demonstrating that single-dose SRS along with WBRT is superior to WBRT alone for improving patient survival for patients with single or multiple brain metastases and a KPS < 70. SRS plus WBRT vs. SRS alone Level 2 Single-dose SRS alone may provide an equivalent survival advantage for patients with brain metastases compared with WBRT + single-dose SRS. There is conflicting class I and II evidence regarding the risk of both local and distant recurrence when SRS is used in isolation, and class I evidence demonstrates a lower risk of distant recurrence with WBRT; thus, regular careful surveillance is warranted for patients treated with SRS alone in order to provide early identification of local and distant recurrences so that salvage therapy can be initiated at the soonest possible time. Surgical Resection plus WBRT vs. SRS +/- WBRT Level 2 Surgical resection plus WBRT, vs. 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. SRS alone vs. WBRT alone Level 3 While both single-dose SRS and WBRT are effective for treating patients with brain metastases, single-dose SRS alone appears to be superior to WBRT alone for patients with up to three metastatic brain tumors in terms of patient survival advantage.
Figures
Similar articles
-
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors.Neurosurgery. 2019 Mar 1;84(3):E152-E155. doi: 10.1093/neuros/nyy542. Neurosurgery. 2019. PMID: 30629227
-
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.Neurosurgery. 2019 Mar 1;84(3):E159-E162. doi: 10.1093/neuros/nyy541. Neurosurgery. 2019. PMID: 30629211
-
Clinical outcomes of stereotactic radiosurgery in the treatment of patients with metastatic brain tumors.World Neurosurg. 2011 May-Jun;75(5-6):673-83. doi: 10.1016/j.wneu.2010.12.006. World Neurosurg. 2011. PMID: 21704935 Review.
-
The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.J Neurooncol. 2010 Jan;96(1):17-32. doi: 10.1007/s11060-009-0060-9. Epub 2009 Dec 4. J Neurooncol. 2010. PMID: 19960231 Free PMC article. Review.
-
The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.J Neurooncol. 2010 Jan;96(1):33-43. doi: 10.1007/s11060-009-0061-8. Epub 2009 Dec 4. J Neurooncol. 2010. PMID: 19960230 Free PMC article. Review.
Cited by
-
Response of treatment-naive brain metastases to stereotactic radiosurgery.Nat Commun. 2024 May 2;15(1):3728. doi: 10.1038/s41467-024-47998-8. Nat Commun. 2024. PMID: 38697991 Free PMC article.
-
How Does the Number of Brain Metastases Correlate With Normal Brain Exposure in Single-Isocenter Multitarget Multifraction Stereotactic Radiosurgery.Adv Radiat Oncol. 2024 Mar 19;9(6):101499. doi: 10.1016/j.adro.2024.101499. eCollection 2024 Jun. Adv Radiat Oncol. 2024. PMID: 38681891 Free PMC article.
-
Prognosis versus Actual Outcomes in Stereotactic Radiosurgery of Brain Metastases: Reliability of Common Prognostic Parameters and Indices.Curr Oncol. 2024 Mar 26;31(4):1739-1751. doi: 10.3390/curroncol31040132. Curr Oncol. 2024. PMID: 38668035 Free PMC article.
-
Outcomes of 2-SSRS plus bevacizumab therapy strategy for brainstem metastases (BSM) over 2 cm3: a multi-center study.Neurosurg Rev. 2024 Apr 2;47(1):137. doi: 10.1007/s10143-024-02369-1. Neurosurg Rev. 2024. PMID: 38564039
-
Multi-institutional study of 'Sandwich treatment' for motor area large brain metastases (LBM) with diameter over 3 cm.Radiol Oncol. 2024 Jan 6;58(1):145-152. doi: 10.2478/raon-2024-0002. eCollection 2024 Mar 1. Radiol Oncol. 2024. PMID: 38183280 Free PMC article.
References
-
- American Cancer Society (2008) Cancer facts & figures 2008. http://www.cancer.org/docroot/stt/content/stt_1x_cancer_facts_and_figure...
-
- Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol. 1978;19:579–592. - PubMed
-
- Theodore WH, Gendelman S. Meningeal carcinomatosis. Arch Neurol. 1981;38:696–699. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical