Brain metastases

Metastases to the central nervous system may occur with tumours of any primary origin. Brain (cerebral) metastases may be either single or multiple, with or without disseminated disease elsewhere. Brain metastases may present with focal or generalised symptoms, although up to a third of patients may be asymptomatic.

We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions for managing brain metastases in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare Regulatory Agency (MHRA).

We identified 18 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We have performed a GRADE evaluation of the quality of evidence for interventions included in this review.

In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids; cytotoxic chemotherapy (systemic); radiation sensitisers plus whole-brain radiotherapy (external beam); surgery; radiosurgery; surgery plus radiosurgery; surgery plus radiosurgery plus whole-brain radiotherapy (external beam); surgery plus whole-brain radiotherapy (external beam); whole-brain radiotherapy (external beam); and whole-brain radiotherapy plus radiosurgery.