The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.
The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.
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DOI：
10.1007/s11060-009-0061-8
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发表时间：
2010-01
影响因子：
3.9
通讯作者：
Linskey, Mark E.
中科院分区：
文献类型：
--
作者：
Kalkanis, Steven N.;Kondziolka, Douglas;Gaspar, Laurie E.;Burri, Stuart H.;Asher, Anthony L.;Cobbs, Charles S.;Ammirati, Mario;Robinson, Paula D.;Andrews, David W.;Loeffler, Jay S.;McDermott, Michael;Mehta, Minesh P.;Mikkelsen, Tom;Olson, Jeffrey J.;Paleologos, Nina A.;Patchell, Roy A.;Ryken, Timothy C.;Linskey, Mark E.
关键词：
新诊断的转移性脑肿瘤患者是否应该接受开放手术切除，还是接受全脑放射治疗 (WBRT) 和/或放射外科等其他治疗方式，以及在什么临床环境下进行？ 目标人群这些建议适用于新诊断出适合手术切除的单脑转移瘤的成年人。 建议 手术切除加 WBRT 与单独手术切除 1 级 与单独手术切除相比，就改善原转移部位和整个大脑的肿瘤控制而言，手术切除后进行 WBRT 是一种优越的治疗方式。 手术切除加 WBRT 与 SRS ± WBRT 2 级手术切除加 WBRT 与立体定向放射外科 (SRS) 加 WBRT 相比，两者都代表了有效的治疗策略，从而获得相对相同的生存率。尚未从基于证据的角度对较大病变 (>3 cm) 或引起显着肿块效应 (>1 cm 中线移位) 的 SRS 进行评估。 3 级证据不足的 I 类证据以及大量相互冲突的 II 类证据表明，对于单发脑转移瘤患者，单独 SRS 与切除+ WBRT 相比，可以提供同等的功能和生存结果，只要可以随时检测远处部位故障并进行挽救性 SRS。 注意 Gaspar 等人在本系列的 WBRT 指南文件中充分解决了以下问题。鉴于对有关该主题的文献进行系统回顾所得出的建议也与手术切除在脑转移治疗中的作用的讨论高度相关，因此该建议已包含在下文中。 问题 与单独进行 WBRT 相比，手术切除联合 WBRT 是否可以改善预后？ 目标人群 本建议适用于新诊断出的单发脑转移瘤且适合手术切除的成年人；然而，该建议不适用于相对放射敏感的肿瘤组织学（即小细胞肺癌、白血病、淋巴瘤、生殖细胞肿瘤和多发性骨髓瘤）。 建议 手术切除加 WBRT 与单独 WBRT 比较 1 级 I 级证据支持，与单独 WBRT 相比，对于体力状态良好（功能独立且卧床时间少于 50%）且颅外疾病有限的患者使用手术切除加术后 WBRT。没有足够的证据为体能评分较差、晚期全身性疾病或多发性脑转移的患者提出建议。
Should patients with newly-diagnosed metastatic brain tumors undergo open surgical resection versus whole brain radiation therapy (WBRT) and/or other treatment modalities such as radiosurgery, and in what clinical settings? Target population These recommendations apply to adults with a newly diagnosed single brain metastasis amenable to surgical resection. Recommendations Surgical resection plus WBRT versus surgical resection alone Level 1 Surgical resection followed by WBRT represents a superior treatment modality, in terms of improving tumor control at the original site of the metastasis and in the brain overall, when compared to surgical resection alone. Surgical resection plus WBRT versus SRS ± WBRT Level 2 Surgical resection plus WBRT, versus stereotactic radiosurgery (SRS) plus WBRT, both represent effective treatment strategies, resulting in relatively equal survival rates. SRS has not been assessed from an evidence-based standpoint for larger lesions (>3 cm) or for those causing significant mass effect (>1 cm midline shift). Level 3 Underpowered class I evidence along with the preponderance of conflicting class II evidence suggests that SRS alone may provide equivalent functional and survival outcomes compared with resection + WBRT for patients with single brain metastases, so long as ready detection of distant site failure and salvage SRS are possible. Note The following question is fully addressed in the WBRT guideline paper within this series by Gaspar et al. Given that the recommendation resulting from the systematic review of the literature on this topic is also highly relevant to the discussion of the role of surgical resection in the management of brain metastases, this recommendation has been included below. Question Does surgical resection in addition to WBRT improve outcomes when compared with WBRT alone? Target population This recommendation applies to adults with a newly diagnosed single brain metastasis amenable to surgical resection; however, the recommendation does not apply to relatively radiosensitive tumors histologies (i.e., small cell lung cancer, leukemia, lymphoma, germ cell tumors and multiple myeloma). Recommendation Surgical resection plus WBRT versus WBRT alone Level 1 Class I evidence supports the use of surgical resection plus post-operative WBRT, as compared to WBRT alone, in patients with good performance status (functionally independent and spending less than 50% of time in bed) and limited extra-cranial disease. There is insufficient evidence to make a recommendation for patients with poor performance scores, advanced systemic disease, or multiple brain metastases.
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影响因子：
3.2
作者：
Maher, CG;Sherrington, C;Elkins, M
通讯作者：
Elkins, M
DOI：
10.1016/s0360-3016(02)04379-1
发表时间：
2003-04-01
影响因子：
7
作者：
O'Neill, BP;Iturria, NJ;O'Fallon, JR
通讯作者：
O'Fallon, JR
DOI：
10.1016/s0360-3016(00)00804-x
发表时间：
2000-12-01
影响因子：
7
作者：
Ikushima, H;Tokuuye, K;Nomura, K
通讯作者：
Nomura, K
影响因子：
45.3
作者：
ARMSTRONG, JG;WRONSKI, M;BURT, M
通讯作者：
BURT, M
立体定向放射外科手术在新诊断的脑转移患者的管理中的作用：系统审查和基于证据的临床实践指南。
影响因子：
3.9
作者：
Linskey, Mark E.;Andrews, David W.;Asher, Anthony L.;Burri, Stuart H.;Kondziolka, Douglas;Robinson, Paula D.;Ammirati, Mario;Cobbs, Charles S.;Gaspar, Laurie E.;Loeffler, Jay S.;McDermott, Michael;Mehta, Minesh P.;Mikkelsen, Tom;Olson, Jeffrey J.;Paleologos, Nina A.;Patchell, Roy A.;Ryken, Timothy C.;Kalkanis, Steven N.
通讯作者：
Kalkanis, Steven N.