Jefferson Neurosurgeon Helps Draft First Evidence-Based, Multidisciplinary Treatment Guidelines for Patients with Brain Metastases
New
treatment guidelines for patients with brain metastases are now
available from the American Association of Neurological Surgeons (AANS)
and the Congress of Neurological Surgeons (CNS). David Andrews, M.D.,
F.A.C.S., professor and vice-chair of Clinical Services in the
Department of Neurological Surgery at Jefferson Hospital for Neuroscience,
served as a member of the task force chosen to draft this new,
significant tool to improve the quality of care for patients who suffer
from brain tumors. The nation’s neurosurgeons took the lead in
drafting the first national evidence-based, multidisciplinary
guidelines for these types of patients, which account for nearly
500,000 new cancers in the United States. Brain metastases are tumors
which travel to the brain from other areas of the body, usually the
breast or lung, and outnumber all other brain tumors combined by more
than four to one.
The
guidelines were developed over the last year by a 20-member panel in
various specialties in conjunction with the McMaster Evidence-based
Practice Center, which is world-renowned for its seminal work in
evidence-based medicine (EBM). The formal EBM process involved
reviewing the literature and reaching a multidisciplinary consensus for
different treatments. Unlike previous formal expert consensus efforts,
recommendations are directly linked to levels of evidence in a
transparent and reproducible methodology. Members of the panel
analyzed 25,000 studies and then utilized 400 of them to make their
final guideline decisions.
“A
decade ago, a brain metastasis diagnosis was a death sentence. But
advancements in technology and treatment like surgical resection,
stereotactic radiosurgery, whole brain radiation therapy, partial brain
radiation and chemotherapy, now allow for better patient outcomes,”
said Dr. Andrews. “Until now, there has been no formally adopted way
to treat these patients. Physicians also lacked a critical central
resource of treatment regimens offering the best results. These new
evidence-based guidelines offer us the opportunity to discuss with our
patients the best available treatment option for them.”
Of
the 1.4 million individuals with cancer in 2008, 30 to 40 percent will
develop brain metastasis compared to the approximately 17,000 new cases
annually of primary malignant brain tumors, cancers that originate in
the brain. The primary goal of these new guidelines is to identify
best treatment practices leading to the best outcomes for patients. In
cases where there was not enough data to suggest a guideline or
recommendation for a particular treatment, the group listed all of the
relevant ongoing clinical trials in their report, as well as needed
future studies, to inform the medical community and to foster support
for continuing this 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 also by the AANS/CNS Joint Tumor Section as well as
experts from a wide range of multidisciplinary fields, including:
radiation oncology, medical oncology and neuro-oncology, and
neurosurgery.
The guidelines are set to be published in a special issue of the Journal of Neuro-Oncology.
Media Only Contact:
Ed Federico
Thomas Jefferson University Hospital
Phone: (215) 955-6300
Published: 12/10/2009