Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults with Metastatic Brain Tumors

Brian V. Nahed, Christopher Alvarez-Breckenridge, Priscilla K. Brastianos, Helen Shih, Andrew Sloan, Mario Ammirati, John Kuo, Timothy C. Ryken, Steven N. Kalkanis, Jeffrey J. Olson

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Please see the full-text version of this guideline https://www.cns.org/guidelines/guidelinestreatment- adults-metastatic-brain-tumors/chapter-2) for the target population of each recommendation listed below. SURGERY FOR METASTATIC BRAIN TUMORS AT NEWDIAGNOSIS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgery, stereotactic radiosurgery (SRS), or whole brain radiotherapy (WBRT)? RECOMMENDATIONS: Level 1: Surgery + WBRT is recommended as first-line treatment in patients with single brain metastases with favorable performance status and limited extracranial disease to extend overall survival, median survival, and local control. Level 3: Surgery plus SRS is recommended to provide survival benefit in patients with metastatic brain tumors Level 3: Multimodal treatments including either surgery + WBRT + SRS boost or surgery + WBRT are recommended as alternatives to WBRT + SRS in terms of providing overall survival and local control benefits. SURGERY AND RADIATION FORMETASTATIC BRAIN TUMORS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgical resection followed by WBRT, SRS, or another combination of these modalities? RECOMMENDATIONS: Level 1: Surgery + WBRT is recommended as superior treatment to WBRT alone in patients with single brain metastases. Level 3: Surgery + SRS is recommended as an alternative to treatment with SRS alone to benefit overall survival. Level 3: It is recommended that SRS alone be considered equivalent to surgery + WBRT. SURGERY FOR RECURRENT METASTATIC BRAIN TUMORS QUESTION: Should patients with recurrent metastatic brain tumors undergo surgical resection? RECOMMENDATION: Level 3: Craniotomy is recommended as a treatment for intracranial recurrence after initial surgery or SRS. SURGICAL TECHNIQUE AND RECURRENCE QUESTIONA: Does the surgical technique (en bloc resection or piecemeal resection) affect recurrence? RECOMMENDATION: Level 3: En bloc tumor resection, as opposed to piecemeal resection, is recommended to decrease the risk of postoperative leptomeningeal disease when resecting single brain metastases. QUESTION B: Does the extent of surgical resection (gross total resection or subtotal resection) affect recurrence? RECOMMENDATION: Level 3: Gross total resection is recommended over subtotal resection in recursive partitioning analysis class I patients to improve overall survival and prolong time to recurrence. The full guideline can be found at https://www.cns.org/guidelines/guidelinestreatment-adults-metastatic-brain-tumors/chapter-2.

Original languageEnglish (US)
Pages (from-to)E152-E155
JournalClinical Neurosurgery
Volume84
Issue number3
DOIs
StatePublished - Mar 1 2019

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Brain Neoplasms
Radiosurgery
Guidelines
Radiotherapy
Brain
Survival
Recurrence
Neoplasm Metastasis
Combined Modality Therapy
Craniotomy
Health Services Needs and Demand
Therapeutics
Radiation

Keywords

  • Brain metastases
  • Cerebral metastases
  • Chemotherapy
  • Intracranial metastatic disease
  • Observation
  • Radiation
  • Recurrent metastatic brain tumors
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults with Metastatic Brain Tumors. / Nahed, Brian V.; Alvarez-Breckenridge, Christopher; Brastianos, Priscilla K.; Shih, Helen; Sloan, Andrew; Ammirati, Mario; Kuo, John; Ryken, Timothy C.; Kalkanis, Steven N.; Olson, Jeffrey J.

In: Clinical Neurosurgery, Vol. 84, No. 3, 01.03.2019, p. E152-E155.

Research output: Contribution to journalReview article

Nahed, BV, Alvarez-Breckenridge, C, Brastianos, PK, Shih, H, Sloan, A, Ammirati, M, Kuo, J, Ryken, TC, Kalkanis, SN & Olson, JJ 2019, 'Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults with Metastatic Brain Tumors', Clinical Neurosurgery, vol. 84, no. 3, pp. E152-E155. https://doi.org/10.1093/neuros/nyy542
Nahed, Brian V. ; Alvarez-Breckenridge, Christopher ; Brastianos, Priscilla K. ; Shih, Helen ; Sloan, Andrew ; Ammirati, Mario ; Kuo, John ; Ryken, Timothy C. ; Kalkanis, Steven N. ; Olson, Jeffrey J. / Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults with Metastatic Brain Tumors. In: Clinical Neurosurgery. 2019 ; Vol. 84, No. 3. pp. E152-E155.
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AU - Brastianos, Priscilla K.

AU - Shih, Helen

AU - Sloan, Andrew

AU - Ammirati, Mario

AU - Kuo, John

AU - Ryken, Timothy C.

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AU - Olson, Jeffrey J.

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KW - Intracranial metastatic disease

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KW - Recurrent metastatic brain tumors

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