Project Summary

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The Patient-Centered Outcomes Research Institute (PCORI) commissioned, via the Agency for Healthcare Research and Quality (AHRQ), a systematic evidence review on radiation therapy for brain metastases (BM). This update fulfills a requirement of PCORI’s authorizing mandate, which is “to engage in evidence synthesis, in order to make information from comparative clinical effectiveness research available to patients and providers so that they can make better-informed health care decisions.”

The number of patients with cancer who have been diagnosed with BM is rising. Refined prognostic tools help physicians differentiate patients with BM based on expected survival time. As a result, treatments have become more individualized and focused on effectively managing BM while minimizing neurotoxicity and quality of life disruptions.

In this rapidly evolving area, physicians and patients want to know which radiation therapy treatments to apply to which patients. Whole brain radiation therapy (WBRT), sometimes preceded by surgery, was the standard of care for many years but is associated with significant negative side effects. Other radiotherapies and treatments have more recently gained prominence, including stereotactic radiosurgery (SRS) alone, postsurgery, or in combination with other treatments; and systemic agents alone or in combination with radiation therapies.

The American Society for Radiation Oncology has identified radiation therapy for BM as an important topic for guideline development. The proposed systematic review will utilize evidence from tumors that most commonly metastasize to the brain (lung, breast, and melanoma) and assess the effectiveness and harms of various radiation therapy treatments.

With input from clinical experts and stakeholders, the following Draft Key Questions have been determined:

Key Questions

  1. What is the effectiveness of WBRT, alone or in combination with SRS or systemic therapies, as initial treatment in patients with BM on patient-relevant outcomes and how does effectiveness vary by dose fractionation schedule, patient prognosis, and primary tumor site?
  2. What is the effectiveness of SRS as initial treatment in patients with BM on patient-relevant outcomes and how does effectiveness vary by dose fractionation schedule and addition of systemic therapies? 
  3. What is the effectiveness of postoperative SRS compared to WBRT or observation in patients with BM on patient-relevant outcomes and how does effectiveness vary by dose fractionation schedule?
  4. What are the adverse effects of WBRT, SRS, and systemic therapies for patients with BM?

More on This Project

*These guidelines were developed by an external organization or a third party and PCORI is not responsible for any content contained therein. In addition, PCORI does not fund and is not involved in the creation of clinical practice guidelines.

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Results of This Project

Project Information

Memorandum of Understanding with Agency for Healthcare Research and Quality (AHRQ)
$467,392

Key Dates

14 months
2019
2021

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Last updated: August 3, 2022