The first national treatment guidelines for brain metastases, which account for nearly 500,000 new cancers annually in the United States, were recently released at the Congress of Neurological Surgeons in New Orleans.
The guidelines were developed by a 20-member panel in various specialties over the last year after reviewing the literature and reaching a consensus for different treatments. The panel was headed by neurosurgeon Steven Kalkanis, M.D., co-director of the Hermelin Brain Tumor Center at Henry Ford Hospital in Detroit.
"In the last 10 years, there has been an explosion of new treatments for brain metastases: surgical resection, stereotactic radiosurgery, whole brain radiation therapy, partial brain radiation, chemotherapy and various combinations of all the above," says Dr. Kalkanis.
"Because of the growth of these new technologies, there has been wide variation among physicians in how to treat patients. And there hasn't been a central source on which treatment regimens give the best results," adds Dr. Kalkanis.
"Our primary goal was to identify best treatment practices leading to the best outcomes for patients."
According to Dr. Kalkanis, there were 1.4 million individuals with cancer in 2008. Of those, 30 to 40 percent will develop brain metastasis, tumors which travel to the brain from other areas of the body, usually the breast or lung.
On the other hand, there are about 17,000 new cases annually of primary malignant brain tumors, cancers that originate in the brain.
Significantly, in cases where there was not enough data to suggest a guideline or recommendation for a particular treatment, the report lists all relevant ongoing clinical trials as well as needed future studies to inform the medical community and to foster support for continuing this important research.
The new brain metastases guidelines include:
- a range of therapeutic options for treating brain metastases;
- the existing evidence used to guide decision-making and its limitations;
- the range of diversity in practice patterns and the various demographic factors that influence clinical decisions; and
- the impact of expert reviews of published clinical evidence on practice regarding treatment options for brain metastases.
This strict evidenced-based protocol was endorsed by not only the Congress of Neurological Surgeons and American Association of Neurological Surgeons, but by the Joint Tumor Section and experts from a wide range of multidisciplinary fields including radiation oncology, medical oncology and neuro-oncology, as well as neurosurgery.
The guidelines will be published in a special issue of the Journal of Neuro-Oncology in December.
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