Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Chemotherapy in the Management of Adults With Newly Diagnosed Metastatic Brain Tumors

Jonathan H Sherman; Simon S Lo; Tom Harrod; Alia Hdeib; Yiping Li; Timothy Ryken; Jeffrey J Olson

doi:10.1093/neuros/nyy544

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Chemotherapy in the Management of Adults With Newly Diagnosed Metastatic Brain Tumors

Neurosurgery. 2019 Mar 1;84(3):E175-E177. doi: 10.1093/neuros/nyy544.

Authors

Jonathan H Sherman¹, Simon S Lo², Tom Harrod³, Alia Hdeib⁴, Yiping Li⁵, Timothy Ryken⁶, Jeffrey J Olson⁷

Affiliations

¹ Department of Neurosurgery, The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia.
² Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
³ Himmelfarb Health Sciences Library, The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia.
⁴ Department of Neurological Surgery, Case Western Reserve University, Cleveland, Ohio.
⁵ Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin.
⁶ Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
⁷ Department of Neurosurgery, Emory University, Atlanta, Georgia.

PMID: 30629221
DOI: 10.1093/neuros/nyy544

Abstract

Question 1: Should patients with brain metastases receive chemotherapy in addition to whole brain radiotherapy (WBRT) for the treatment of their brain metastases?

Target population: This recommendation applies to adult patients with newly diagnosed brain metastases amenable to both chemotherapy and radiation treatment.

Recommendations: Level 1: Routine use of chemotherapy following WBRT for brain metastases is not recommended. Level 3: Routine use of WBRT plus temozolomide is recommended as a treatment for patients with triple negative breast cancer.

Question 2: Should patients with brain metastases receive chemotherapy in addition to stereotactic radiosurgery (SRS) for the treatment of their brain metastases?

Recommendations: Level 1: Routine use of chemotherapy following SRS is not recommended. Level 2: SRS is recommended in combination with chemotherapy to improve overall survival and progression free survival in lung adenocarcinoma patients.

Question 3: Should patients with brain metastases receive chemotherapy alone?

Recommendation: Level 1: Routine use of cytotoxic chemotherapy alone for brain metastases is not recommended as it has not been shown to increase overall survival.Please see the full-text version of this guideline (https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_5) for the target population of each recommendation.

Keywords: Brain metastases; Cerebral metastases; Chemotherapy; Practice guideline; Stereotactic radiosurgery; Systematic review; Whole brain radiation therapy.

Publication types

Systematic Review

MeSH terms

Adult
Antineoplastic Agents / therapeutic use*
Brain Neoplasms / diagnosis*
Brain Neoplasms / drug therapy*
Brain Neoplasms / secondary
Congresses as Topic / standards
Cranial Irradiation / standards
Female
Humans
Male
Neurosurgeons / standards*
Practice Guidelines as Topic / standards*
Radiosurgery / standards

Substances

Antineoplastic Agents