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

Sherman, Jonathan H.; Lo, Simon S.; Harrod, Thomas; Hdeib, Alia; Li, Yiping; Ryken, Timothy C.; Olson, Jeffrey J.

doi:10.1093/neuros/nyy544

Cited by 34 publications

(15 citation statements)

References 21 publications

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“…5 This work focuses on these two guidelines selected for endorsement. The two guidelines that were not endorsed reviewed the role of chemotherapy 3 and various emerging therapies. 4 Details on the newly identified evidence found and the review of the unendorsed guidelines can be found in Data Supplement 7.…”

Section: Clinical Question(s) and Target Populationmentioning

confidence: 99%

Anticonvulsant Prophylaxis and Steroid Use in Adults With Metastatic Brain Tumors: ASCO and SNO Endorsement of the Congress of Neurological Surgeons Guidelines

Chang

Messersmith

Ahluwalia

et al. 2019

JCO

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PURPOSE The Congress of Neurological Surgeons (CNS) has developed a series of guidelines for the treatment of adults with metastatic brain tumors, including systemic therapy and supportive care topics. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS Two CNS guidelines were reviewed for developmental rigor by methodologists, and an independent multidisciplinary Expert Panel was formed to review the content and assess agreement with the recommendations. The Expert Panel voted to endorse the two guidelines, and ASCO and Society for Neuro-Oncology (SNO) independently reviewed and approved the ASCO/SNO guideline endorsement. RESULTS The ASCO/SNO Expert Panel determined that the recommendations from the CNS anticonvulsants and steroids guidelines, published January 9, 2019, are clear, thorough, and based on the most relevant scientific evidence. ASCO/SNO endorsed these two CNS guidelines with minor alterations. RECOMMENDATIONS Key recommendations include the following: prophylactic antiepileptic drugs were not recommended for routine use; and corticosteroids, specifically dexamethasone, were recommended for temporary symptomatic relief in patients with neurologic symptoms and signs related to mass effect from brain metastases. Additional information is available at www.asco.org/neurooncology-guidelines .

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Section: Clinical Question(s) and Target Populationmentioning

confidence: 99%

Anticonvulsant Prophylaxis and Steroid Use in Adults With Metastatic Brain Tumors: ASCO and SNO Endorsement of the Congress of Neurological Surgeons Guidelines

Chang

Messersmith

Ahluwalia

et al. 2019

JCO

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“…Rojas-Puentes et al 149 reported results that favored the WBRT plus placebo rather than the WBRT plus chloroquine group (statistical significance not given) and Zeng et al 168 reported longer median central nervous system (CNS) progression-free survival when adding sodium glycididazole (p=0.04). El-Hamamsy et al (simvastatin), 94 and Suh et al 155 (efaproxiral) reported no significant difference between treatment groups.…”

Section: Figure 4 Wbrt Plus Radiosensitizers Versus Wbrt Alone: Overall Survivalmentioning

confidence: 92%

“…We identified 10 RCTs that assessed the effect of adding potential radiosensitizers to WBRT treatment. 94,107,109,127,128,138,149,155,156,168 Figure 4 shows the effect on overall survival in the RCTs reporting on this outcome in sufficient detail. 109,155,156,168…”

Section: Wbrt Plus Radiosensitizers Versus Wbrt Alonementioning

confidence: 99%

“…Mehta et al 127 reported no significant difference between groups for motexafin gadolinium (HR 1.14; CI 0.74 to 1.75; 1 RCT). Suh et al 155 indicated that a larger percentage of patients in the efaproxiral group had stable or improving quality of life scores. Rojas-Puentes, 2013 149 reported no differences between groups with chloroquine and El-Hamamsy et al 94 reported no significant differences for simvastatin.…”

Section: Figure 4 Wbrt Plus Radiosensitizers Versus Wbrt Alone: Overall Survivalmentioning

confidence: 99%

“…Three studies evaluating radiosensitizer in WBRT reported on the number of patients with serious adverse events as shown in Figure 25. 107,138,155…”

Section: Figure 24 Wbrt Plus Srs Versus Wbrt or Srs Alone: Serious Adverse Eventsmentioning

confidence: 99%

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Radiation Therapy for Brain Metasases

Garsa¹,

Jang²,

Baxi³

et al. 2021

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Objective. This evidence report synthesizes the available evidence on radiation therapy for brain metastases. Data sources. We searched PubMed®, Embase®, Web of Science, Scopus, CINAHL®, clinicaltrials.gov, and published guidelines in July 2020; assessed independently submitted data; consulted with experts; and contacted authors. Review methods. The protocol was informed by Key Informants. The systematic review was supported by a Technical Expert Panel and is registered in PROSPERO (CRD42020168260). Two reviewers independently screened citations; data were abstracted by one reviewer and checked by an experienced reviewer. We included randomized controlled trials (RCTs) and large observational studies (for safety assessments), evaluating whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination, as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to non-small cell lung cancer, breast cancer, or melanoma. Results. In total, 97 studies, reported in 190 publications, were identified, but the number of analyses was limited due to different intervention and comparator combinations as well as insufficient reporting of outcome data. Risk of bias varied; 25 trials were terminated early, predominantly due to poor accrual. Most studies evaluated WBRT, alone or in combination with SRS, as initial treatment; 10 RCTs reported on post-surgical interventions. The combination treatment SRS plus WBRT compared to SRS alone or WBRT alone showed no statistically significant difference in overall survival (hazard ratio [HR], 1.09; confidence interval [CI], 0.69 to 1.73; 4 RCTs; low strength of evidence [SoE]) or death due to brain metastases (relative risk [RR], 0.93; CI, 0.48 to 1.81; 3 RCTs; low SoE). Radiation therapy after surgery did not improve overall survival compared with surgery alone (HR, 0.98; CI, 0.76 to 1.26; 5 RCTs; moderate SoE). Data for quality of life, functional status, and cognitive effects were insufficient to determine effects of WBRT, SRS, or post-surgical interventions. We did not find systematic differences across interventions in serious adverse events radiation necrosis, fatigue, or seizures (all low or moderate SoE). WBRT plus systemic therapy (RR, 1.44; CI, 1.03 to 2.00; 14 studies; moderate SoE) was associated with increased risks for vomiting compared to WBRT alone. Conclusion. Despite the substantial research literature on radiation therapy, comparative effectiveness information is limited. There is a need for more data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.

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Local and systemic therapy in breast cancer patients with central nervous system metastases

Wellerdieck

Wessels

Los

et al. 2022

Breast Cancer Res Treat

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Purpose As survival of patients with central nervous system (CNS) metastases from breast cancer is poor and incidence rates are increasing, there is a growing need for better treatment strategies. In the current study, the e cacy of local and systemic therapies was analyzed in breast cancer patients with CNS metastases.Methods Medical records from patients with breast cancer and brain and/or leptomeningeal metastases treated at a tertiary referral center and a teaching hospital between 2010 and 2020 were retrospectively studied. Main outcomes of interest were overall survival and CNS progression free survival. Analyses were performed for the different systemic and local therapies for CNS metastases, and subgroups based on breast cancer subtypes and brain metastases vs leptomeningeal metastases were tested. ResultsWe identi ed 155 patients, 44 HER2-positive, 68 hormone receptor positive/HER2-negative and 43 triple negative. Median overall survival was 5.9 months for all 155 analyzed patients. Survival differed signi cantly between breast cancer subtypes (HER2positive 22.8 months, hormone receptor positive/HER2-negative 2.4 months, triple negative 4.2 months, P<0.001). Patients receiving a combination of local and systemic therapy demonstrated prolonged median overall survival (18.5 months) as compared to local therapy only (5.7 months) or systemic therapy only (4.3 months, P<0.001). No signi cant difference in overall survival was observed between different systemic treatment regimens.Conclusion Breast cancer patients with CNS metastases show longest median overall survival when the subtype is HER2-positive and when they are treated with both local and systemic therapy.

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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

Cited by 34 publications

References 21 publications

Anticonvulsant Prophylaxis and Steroid Use in Adults With Metastatic Brain Tumors: ASCO and SNO Endorsement of the Congress of Neurological Surgeons Guidelines

Anticonvulsant Prophylaxis and Steroid Use in Adults With Metastatic Brain Tumors: ASCO and SNO Endorsement of the Congress of Neurological Surgeons Guidelines

Radiation Therapy for Brain Metasases

Local and systemic therapy in breast cancer patients with central nervous system metastases

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