| Summary: | <p>Abstract</p> <p>Background</p> <p>An evidence-based clinical practice guideline on the optimal radiotherapeutic management of single and multiple brain metastases was developed.</p> <p>Methods</p> <p>A systematic review and meta-analysis was performed. The Supportive Care Guidelines Group formulated clinical recommendations based on their interpretation of the evidence. External review of the report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from Cancer Care Ontario's Practice Guidelines Coordinating Committee (PGCC).</p> <p>Results</p> <p>One hundred and nine Ontario practitioners responded to the survey (return rate 44%). Ninety-six percent of respondents agreed with the interpretation of the evidence, and 92% agreed that the report should be approved. Minor revisions were made based on feedback from external reviewers and the PGCC. The PGCC approved the final practice guideline report.</p> <p>Conclusions</p> <p>For adult patients with a clinical and radiographic diagnosis of brain metastases (single or multiple) we conclude that,</p> <p>• Surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis.</p> <p>• Postoperative whole brain radiotherapy (WBRT) should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis.</p> <p>• Radiosurgery boost with WBRT may improve survival in select patients with unresectable single brain metastases.</p> <p>• The whole brain should be irradiated for multiple brain metastases. Standard dose-fractionation schedules are 3000 cGy in 10 fractions or 2000 cGy in 5 fractions.</p> <p>• Radiosensitizers are not recommended outside research studies.</p> <p>• In select patients, radiosurgery may be considered as boost therapy with WBRT to improve local tumour control. Radiosurgery boost may improve survival in select patients.</p> <p>• Chemotherapy as primary therapy or chemotherapy with WBRT remains experimental.</p> <p>• Supportive care is an option but there is a lack of Level 1 evidence as to which subsets of patients should be managed with supportive care alone.</p> <p>Qualifying statements addressing factors to consider when applying these recommendations are provided in the full report. The rigorous development, external review and approval process has resulted in a practice guideline that is strongly endorsed by Ontario practitioners.</p>
|
|---|