Linked Life Data

19960230

Source:http://linkedlifedata.com/resource/pubmed/id/19960230

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
1
pubmed:dateCreated
2010-1-20
pubmed:abstractText
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 +/- 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. Question Does surgical resection in addition to WBRT improve outcomes when compared with WBRT alone? Target population This recommendation applies to adults with a newly diagnosed single brain metastasis amenable to surgical resection; however, the recommendation does not apply to relatively radiosensitive tumors histologies (i.e., small cell lung cancer, leukemia, lymphoma, germ cell tumors and multiple myeloma). Recommendation Surgical resection plus WBRT versus WBRT alone Level 1 Class I evidence supports the use of surgical resection plus post-operative WBRT, as compared to WBRT alone, in patients with good performance status (functionally independent and spending less than 50% of time in bed) and limited extra-cranial disease. There is insufficient evidence to make a recommendation for patients with poor performance scores, advanced systemic disease, or multiple brain metastases.
pubmed:commentsCorrections
http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-10389878, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-11121638, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-12416548, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-12566833, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-12654423, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-12882612, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-15596921, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-16215811, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-17240553, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-17487853, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-18157648, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-2296364, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-2405271, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-7964950, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-8498838, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-8622147, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-8646510, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-8839553, http://linkedlifedata.com/resource/pubmed/commentcorrection/19960230-9809728
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:status
MEDLINE
pubmed:month
Jan
pubmed:issn
1573-7373
pubmed:author
pubmed:issnType
Electronic
pubmed:volume
96
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
33-43
pubmed:dateRevised
2010-10-19
pubmed:meshHeading
pubmed:year
2010
pubmed:articleTitle
The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.
pubmed:affiliation
Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Blvd, K-11, Detroit, MI 48202, USA. kalkanis@neuro.hfh.edu
pubmed:publicationType
Journal Article, Review