International practice survey on the management of brain metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control.


Journal Article

AIM: To evaluate international patterns of practice for the management of metastatic disease to the brain. MATERIALS AND METHODS: An online international practice survey was conducted from April to June 2010. Most of the survey questions were based on common management issues for which optimal management using level 1 evidence was lacking. The survey consisted of three sections: respondent demographics, 13 general questions regarding surgery, whole brain radiotherapy (WBRT) and radiosurgery and 13 questions related to specific scenarios. RESULTS: In total, 445 individuals responded to the survey over a 3 month period. Ninety per cent of respondents worked in a hospital-based setting. Ninety-three per cent of respondents were radiation oncologists. Thirty-seven per cent worked in an academic setting. Only three of 26 survey questions generated at least 70% agreement for a favoured response. Eighty-eight per cent of respondents chose comfort measures only for patients with multiple brain metastases who have been previously treated with WBRT and who now present 6 months later with two to four brain metastases (all less than 4 cm in size) with uncontrolled extracranial disease and bedridden state. Seventy-eight per cent of respondents would use WBRT alone for initial treatment in patients with two to four brain metastases (all less than 4 cm in size), with active, uncontrolled extracranial disease and a Karnofsky performance status of 70. Seventy-eight per cent of respondents chose surgical resection for an enlarging single brain metastasis that has been previously treated with radiosurgery. The enlarging single brain metastasis is in a surgically accessible site and is now symptomatic. The patient has controlled extracranial disease, good performance status and magnetic resonance spectroscopy was not diagnostic. CONCLUSIONS: There is a lack of uniform agreement for many common management issues (not well answered by level 1 evidence) in patients with metastatic disease to the brain.

Full Text

Duke Authors

Cited Authors

  • Tsao, MN; Rades, D; Wirth, A; Lo, SS; Danielson, BL; Vichare, A; Hahn, C; Chang, EL

Published Date

  • August 2012

Published In

Volume / Issue

  • 24 / 6

Start / End Page

  • e81 - e92

PubMed ID

  • 22794327

Pubmed Central ID

  • 22794327

Electronic International Standard Serial Number (EISSN)

  • 1433-2981

Digital Object Identifier (DOI)

  • 10.1016/j.clon.2012.03.008


  • eng

Conference Location

  • England