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1、EVIDENCE-BASEDSERIES#9-1(VERSION2.2006)Evidence-basedSeries#9-1(Version2.2006):Section1ManagementofSingleBrainMetastases:AClinicalPracticeGuidelineA.P.Mintz,J.Perry,N.Laperriere,G.Cairncross,A.Chambers,K.Spithoff,andtheNeuro-OncologyDiseaseSiteGroupAQualityInitiativeof
2、thePrograminEvidence-basedCare(PEBC),CancerCareOntario(CCO)DevelopedbytheNeuro-OncologyDiseaseSiteGroupReportDate:August15,2006ThisEvidence-basedSeriesreportreplacesanearlierversionofthereportthatwascompletedin2004.Questions1.Shouldpatientswithconfirmedsinglebrainmetas
3、taseshavesurgicalresection?2.Shouldpatientswithsinglebrainmetastasesundergoingsurgicalresectionreceiveadjuvantwholebrainradiationtherapy(WBRT)?3.Whatistheroleofstereotacticradiosurgery(SRS)inthemanagementofpatientswithsinglebrainmetastases?Outcomesofinterestweresurviva
4、l,localcontrolofdisease,qualityoflife,andadverseeffects.TargetPopulationTheserecommendationsapplytoadultswithconfirmedcancerandasinglebrainmetastasis.Thispracticeguidelinedoesnotapplytopatientswithmetastaticlymphoma,smallcelllungcancer,germcelltumour,leukemia,orsarcoma
5、.RecommendationsSurgicalexcisionshouldbeconsideredforpatientswithgoodperformancestatus,minimalornoevidenceofextracranialdisease,andasurgicallyaccessiblesinglebrainmetastasisamenabletocompleteexcision.Sincetreatmentinthisdiseaseisconsideredpalliative,invasivelocaltreatm
6、entsmustbeindividualized.Patientswithlesionsrequiringemergencydecompressionduetointracranialhypertensionwereexcludedfromtherandomizedcontrolledtrialsbutshouldbeconsideredtobesurgicalcandidates.PostoperativeWBRTshouldbeconsideredtoreducetheriskoftumourrecurrenceforpatie
7、ntswhohaveundergoneresectionofasinglebrainmetastasis.Theoptimaldoseandfractionationscheduleforwholebrainradiationtherapyis3,000cGyin10fractionsor2,000cGyinfivefractions.SRSboostshouldbeconsideredfollowingWBRTforpatientswithsinglemetastases.Thereisinsufficientevidenceto
8、recommendSRSaloneassinglemodalitytherapy.PRACTICEGUIDELINE–page1EVIDENCE-BASEDSERIES#9-1(VERSION2.2006)QualifyingStat
