Brain metastases – Clinical Evidence BMJ

Brain metastases

New condition.
New option(s) added for:

Corticosteroids New option. One systematic review found (search date 2003) which identified no RCTs comparing corticosteroids versus no corticosteroids.Three systematic reviews found (search date 2003, search date 2004)
which identified the same small RCT (48 people) comparing corticosteroids versus corticosteroids plus whole-brain radiotherapy. ‘Corticosteroids’ categorised as Likely to be beneficial (categorisation made by consensus as insufficient RCT evidence found).

Cytotoxic chemotherapy (systemic) New option. Three RCTs identified comparing either carboplatin plus whole-brain radiotherapy (WBRT) versus WBRT aloneor temozolomide plus WBRT versus WBRT alone.
Two of the RCTs were terminated prematurely because of poor participant accrual. ‘Cytotoxic chemotherapy (systemic)’ categorised as Unknown effectiveness.

Surgery New option. One systematic review (search date 2004) foundwhich identified no RCTs comparing surgery versus radiosurgery. One systematic review found (search date 2004) which identified one RCT (95 people) comparing surgery versus surgery plus whole-brain radiotherapy. ‘Surgery’ categorised as Unknown effectiveness.

Surgery plus whole-brain radiotherapy (external beam) New option. One systematic review found (search date 2004) which identified one RCT (95 people) comparing surgery plus whole brain radiotherapy (WBRT) versus surgery alone. Two systematic reviews found (search date 2003; search date 2004) which identified the same three RCTs

comparing surgery plus WBRT versus WBRT alone. ‘Surgery plus WBRT (external beam)’ categorised as Unknown effectiveness.

Surgery plus radiosurgery New option. No RCTs found. ‘Surgery plus radiosurgery’ categorised as Unknown effectiveness.

Surgery plus radiosurgery plus whole-brain radiotherapy (external beam) New option. No RCTs found. ‘Surgery plus radiosurgery plus whole-brain radiotherapy (external beam)’ categorised as Unknown effectiveness.

Whole-brain radiotherapy (external beam ) New option. Three systematic reviews found (search date 2003, search date 2004)
which identified the same small RCT (48 people) comparing corticosteroids plus whole-brain radiotherapy (WBRT) versus corticosteroids. Two systematic reviews found (search date 2003; search date 2004) which identified the same three RCTs

comparing WBRT versus WBRT plus surgery. Three RCTs identified comparing either carboplatin plus WBRT versus WBRT aloneor temozolomide plus WBRT versus WBRT alone.
Two of these RCTs were terminated prematurely because of poor participant accrual. Two systematic reviews (search date 2004)
and one subsequently fully published RCTfound comparing WBRT plus radiation sensitisers versus WBRT alone. Three systematic reviews (search date 2004;
search date not reported) found comparing WBRT versus WBRT plus radiosurgery. One further systematic review (search date 2004)which was a narrative review including both RCT and observational data added to the harms section and comments as background data. ‘Whole-brain radiotherapy (external beam) (addition of some other interventions to WBRT may be no more effective than WBRT alone; WBRT alone may be effective in selected people)’ categorised as Likely to be beneficial.

Radiation sensitisers plus whole-brain radiotherapy (external beam) New option. Two systematic reviews found (search date 2004)
and one subsequently fully published RCTcomparing whole-brain radiotherapy (WBRT) plus radiation sensitisers versus WBRT alone. ‘Radiation sensitisers (no evidence that adding radiation sensitisers to WBRT is more effective than WBRT alone)’ categorised as Unlikely to be beneficial.

Whole-brain radiotherapy (external beam) plus radiosurgery New option. Three systematic reviews found (search date 2004;
search date not reported) comparing whole-brain radiotherapy (WBRT) plus radiosurgery versus WBRT alone. One systematic review found (search date 2004) which identified one RCT in abstract form which has subsequently been published in full, comparing WBRT plus radiosurgery versus radiosurgery alone. ‘Whole-brain radiotherapy (external beam) (WBRT) plus radiosurgery (some evidence of improved survival in people with a single unresectable brain metastasis with WBRT plus radiosurgery compared with WBRT alone; no evidence of improved survival in people with multiple brain metastasis)’ categorised as Unknown effectiveness.

Radiosurgery (stereotactic LINAC radiotherapy or gamma knife) New option. One systematic review found (search date 2004) which identified one RCT in abstract form now subsequently published in full, comparing radiosurgery versus whole-brain radiotherapy plus radiosurgery. One systematic review (search date 2004) foundwhich identified no RCTs comparing radiosurgery versus surgery. ‘Radiosurgery (stereotactic LINAC radiotherapy or gamma knife)’ categorised as Unknown effectiveness.

http://clinicalevidence.bmj.com/ceweb/conditions/nud/1018/1018.jsp?rss=true

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