AIM: To evaluate international patterns of practice for the management of metastatic disease to the brain. MATERIALS AND METHODS: An online international practice survey was conducted from April to June 2010. Most of the survey questions were based on common management issues for which optimal management using level 1 evidence was lacking. The survey consisted of three sections: respondent demographics, 13 general questions regarding surgery, whole brain radiotherapy (WBRT) and radiosurgery and 13 questions related to specific scenarios. RESULTS: In total, 445 individuals responded to the survey over a 3 month period. Ninety per cent of respondents worked in a hospital-based setting. Ninety-three per cent of respondents were radiation oncologists. Thirty-seven per cent worked in an academic setting. Only three of 26 survey questions generated at least 70% agreement for a favoured response. Eighty-eight per cent of respondents chose comfort measures only for patients with multiple brain metastases who have been previously treated with WBRT and who now present 6 months later with two to four brain metastases (all less than 4 cm in size) with uncontrolled extracranial disease and bedridden state. Seventy-eight per cent of respondents would use WBRT alone for initial treatment in patients with two to four brain metastases (all less than 4 cm in size), with active, uncontrolled extracranial disease and a Karnofsky performance status of 70. Seventy-eight per cent of respondents chose surgical resection for an enlarging single brain metastasis that has been previously treated with radiosurgery. The enlarging single brain metastasis is in a surgically accessible site and is now symptomatic. The patient has controlled extracranial disease, good performance status and magnetic resonance spectroscopy was not diagnostic. CONCLUSIONS: There is a lack of uniform agreement for many common management issues (not well answered by level 1 evidence) in patients with metastatic disease to the brain.
AIM: To evaluate international patterns of practice for the management of metastatic disease to the brain. MATERIALS AND METHODS: An online international practice survey was conducted from April to June 2010. Most of the survey questions were based on common management issues for which optimal management using level 1 evidence was lacking. The survey consisted of three sections: respondent demographics, 13 general questions regarding surgery, whole brain radiotherapy (WBRT) and radiosurgery and 13 questions related to specific scenarios. RESULTS: In total, 445 individuals responded to the survey over a 3 month period. Ninety per cent of respondents worked in a hospital-based setting. Ninety-three per cent of respondents were radiation oncologists. Thirty-seven per cent worked in an academic setting. Only three of 26 survey questions generated at least 70% agreement for a favoured response. Eighty-eight per cent of respondents chose comfort measures only for patients with multiple brain metastases who have been previously treated with WBRT and who now present 6 months later with two to four brain metastases (all less than 4 cm in size) with uncontrolled extracranial disease and bedridden state. Seventy-eight per cent of respondents would use WBRT alone for initial treatment in patients with two to four brain metastases (all less than 4 cm in size), with active, uncontrolled extracranial disease and a Karnofsky performance status of 70. Seventy-eight per cent of respondents chose surgical resection for an enlarging single brain metastasis that has been previously treated with radiosurgery. The enlarging single brain metastasis is in a surgically accessible site and is now symptomatic. The patient has controlled extracranial disease, good performance status and magnetic resonance spectroscopy was not diagnostic. CONCLUSIONS: There is a lack of uniform agreement for many common management issues (not well answered by level 1 evidence) in patients with metastatic disease to the brain.
Authors: Marcel A Kamp; Philipp J Slotty; Jan F Cornelius; Hans-Jakob Steiger; Marion Rapp; Michael Sabel Journal: Neurosurg Rev Date: 2016-07-09 Impact factor: 3.042
Authors: Or Cohen-Inbar; Zhiyuan Xu; Blair Dodson; Tanvir Rizvi; Christopher R Durst; Sugoto Mukherjee; Jason P Sheehan Journal: J Neurooncol Date: 2016-08-27 Impact factor: 4.130
Authors: Carsten Nieder; Jan Norum; Astrid Dalhaug; Gro Aandahl; Kirsten Engljähringer Journal: Support Care Cancer Date: 2013-05-18 Impact factor: 3.603
Authors: Daniel H Kim; Timothy E Schultheiss; Eric H Radany; Behnam Badie; Richard D Pezner Journal: J Neurooncol Date: 2013-06-28 Impact factor: 4.130
Authors: Michael H Soike; Emory R McTyre; Ryan T Hughes; Michael Farris; Christina K Cramer; Michael C LeCompte; Claire M Lanier; Jimmy Ruiz; Jing Su; Kounosuke Watabe; J Daniel Bourland; Michael T Munley; Stacey O'Neill; Adrian W Laxton; Stephen B Tatter; Michael D Chan Journal: J Neurooncol Date: 2018-05-08 Impact factor: 4.130
Authors: Alessia Reali; Simona Allis; Andrea Girardi; Roberta Verna; Lavinia Bianco; Maria Grazia Ruo Redda Journal: Indian J Palliat Care Date: 2015 Sep-Dec