Affordable Access

Publisher Website

What is the randomised evidence for surgery and stereotactic radiosurgery for patients with solitary (or few) brain metastases?

Authors
Type
Published Article
Journal
International journal of evidence-based healthcare
Publication Date
Volume
9
Issue
1
Pages
61–66
Identifiers
DOI: 10.1111/j.1744-1609.2010.00201.x
PMID: 21332664
Source
Medline

Abstract

Patients with solitary (or few) brain metastases are often treated with surgery (S) or stereotactic radiosurgery (SRS) with or without adjuvant whole brain radiotherapy (WBRT). This review examines the randomised evidence supporting this aggressive approach. A search of MEDLINE, EMBASE and Cochrane databases for published papers and Abstracts on relevant randomised trials was undertaken. Fourteen randomised trials were identified, 11 final reports and 3 Abstracts, investigating various combinations of S, SRS and WBRT. Most of these trials had significant limitations and the results therefore need to be viewed with caution. Surgery and SRS improve local control, maintenance of performance status and survival for favourable prognosis patients with solitary brain metastases relative to WBRT alone, although the absolute survival benefit for the majority is modest. Limited data suggest similar outcomes from S and SRS, but few patients are truly suitable for both options. For multiple (2-4) brain metastases, SRS improves local control and functional outcome but not survival; there is no randomised evidence for S. Adjuvant WBRT also improves intracranial control but not survival; however, the neurocognitive risk : benefit ratio of WBRT remains controversial. Quality of life data are currently limited.

There are no comments yet on this publication. Be the first to share your thoughts.

Statistics

Seen <100 times
0 Comments
F