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 one third of people 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 March 2010 (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 products Regulatory Agency (MHRA).

We identified 38 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, surgery, radiosurgery, whole-brain radiotherapy (external beam), cytotoxic chemotherapy (systemic), surgery plus radiosurgery, surgery plus whole-brain radiotherapy (external beam), whole-brain radiotherapy plus radiosurgery, surgery plus radiosurgery plus whole-brain radiotherapy (external beam), and whole-brain radiotherapy (external beam) plus radiation sensitisers.