Practice parameters for the management of single brain metastasis

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Object

In January 1998 the Guidelines and Outcomes Committee of the American Association of Neurological Surgeons (AANS) issued a charge for the development of evidence-based practice parameters focusing on the treatment of patients with single metastasis to the brain. The charge was imposed in response to the significant controversy surrounding questions relating to the optimal management strategies for patients with single brain metastasis.

Methods

A team consisting of physicians from the AANS, the American Academy of Neurology, and the American Association of Therapeutic Radiation Oncology convened and the literature was reviewed. Methodically drawing from the best of Class I, II, and III levels of available evidence, authors sought to determine how the literature addressed and disposed of the question of the optimal management for an adult with a known history of cancer and a single meta-static brain lesion. Framing the question in this specific manner allowed researchers to focus directly on treatment issues, without having to consider diagnostic issues.

Conclusions

The results of the evidence-based analysis demonstrated that there was insufficient information to establish standards of care. Data from the literature does, however, support a guideline stating that surgical resection accompanied by whole brain radiation therapy is associated with the best survival rate. Additional lower-quality evidence supports an option for management with radiosurgery.

Abbreviations used in this paper:AAN = American Academy of Neurology; AANS = American Association of Neurological Surgeons; ASTRO = American Association of Therapeutic Radiation Oncology; BrdU = bromodeoxyuridine; CNS = central nervous system; CT = computerized tomography; IRS = I-125 seeds; KPS = Karnofsky Performance Scale; MR = magnetic resonance; RS = radiosurgery; RTOG = Radiation Therapy Oncology Group; WBRT = whole-brain radiation therapy.

Object

In January 1998 the Guidelines and Outcomes Committee of the American Association of Neurological Surgeons (AANS) issued a charge for the development of evidence-based practice parameters focusing on the treatment of patients with single metastasis to the brain. The charge was imposed in response to the significant controversy surrounding questions relating to the optimal management strategies for patients with single brain metastasis.

Methods

A team consisting of physicians from the AANS, the American Academy of Neurology, and the American Association of Therapeutic Radiation Oncology convened and the literature was reviewed. Methodically drawing from the best of Class I, II, and III levels of available evidence, authors sought to determine how the literature addressed and disposed of the question of the optimal management for an adult with a known history of cancer and a single meta-static brain lesion. Framing the question in this specific manner allowed researchers to focus directly on treatment issues, without having to consider diagnostic issues.

Conclusions

The results of the evidence-based analysis demonstrated that there was insufficient information to establish standards of care. Data from the literature does, however, support a guideline stating that surgical resection accompanied by whole brain radiation therapy is associated with the best survival rate. Additional lower-quality evidence supports an option for management with radiosurgery.

Abbreviations used in this paper:AAN = American Academy of Neurology; AANS = American Association of Neurological Surgeons; ASTRO = American Association of Therapeutic Radiation Oncology; BrdU = bromodeoxyuridine; CNS = central nervous system; CT = computerized tomography; IRS = I-125 seeds; KPS = Karnofsky Performance Scale; MR = magnetic resonance; RS = radiosurgery; RTOG = Radiation Therapy Oncology Group; WBRT = whole-brain radiation therapy.

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Article Information

Contributor Notes

Address reprint requests to: Jack P. Rock, M.D., Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, Michigan 48202.

© Copyright 1944-2019 American Association of Neurological Surgeons

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