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Brain metastasis management: difficulties with integrating Cochrane review evidence into guidelines

Date and Location




Monday 23 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Michael Hart

Contact person

Michael Hart
Abstract text
Background: Treatment options for brain metastasis include surgery, stereotactic radiosurgery (SRS) or whole brain radiation therapy (WBRT). Multiple randomised controlled trials (RCTs) have been performed comparing various combinations of these therapies. Objectives: To determine if advances in RCT evidence is being synthesised into Cochrane reviews and if this in turn is being used to appropriately formulate evidence based national guidelines. Methods: National guidelines were identified by searching the websites of the major worldwide neuro-oncology associations. Cochrane reviews and randomised controlled trials were identified through searching CENTRAL (issue 3, 2013). Only RCTs comparing wither surgery, SRS or WBRT (either alone or in combination) were included) and categorised into four specific treatment questions (surgery for single metastasis; surgery versus SRS; WBRT +/- SRS; SRS +/- WBRT). Chemotherapy, molecular targeted therapy, radiation sensitisers and different radiation regimes were not eligible for inclusion. Results: A total of 13 RCTs, 4 Cochrane reviews and 3 national guidelines were identified. The Cochrane reviews had some overlap but in total covered 3 of the 4 main treatment questions and 77% of eligible RCTs. National guidelines included 69% of the RCTs in total (range 53-92%) but did not cite any Cochrane reviews. Conclusions: The major limitation to evidence based management of brain metastasis appears to be a lack of integration of Cochrane reviews into national guidelines. Advances in Cochrane methodology, for example multiple-treatment comparisons, minimising review overlap and keeping reviews contemporary may help to make Cochrane review evidence more relevant. Recent formation of the Cochrane neuro-oncology group and a higher profile at international neuro-oncology meetings may help to increase awareness of Cochrane reviews in the neuro-oncology community.