Structured Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Evidence Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
  • Strengths and Limitations
  • Implications and Conclusions
• Introduction
  • Background
  • Purpose and Scope of the Systematic Review
• Methods
  • Review Approach
  • Study Selection
  • Data Extraction and Risk of Bias Assessment
  • Data Synthesis and Analysis
  • Grading the Strength of the Body of Evidence
• Results
  • Description of Included Evidence
  • Key Question 1. What is the effectiveness of WBRT, alone or in combination with SRS or systemic therapies, as initial treatment in patients with brain metastases on patient-relevant outcomes, such as overall survival and quality of life?
  • Key Question 2. What is the effectiveness of SRS/fractionated stereotactic radiation as initial treatment in patients with brain metastases on patient-relevant outcomes, such as overall survival and quality of life?
  • Key Question 3. What is the effectiveness (or comparative effectiveness) of postoperative SRS compared to WBRT, observation, or preoperative SRS in patients with brain metastases on patient-relevant outcomes, such as overall survival and quality of life?
  • Key Question 4. What are the adverse effects (i.e., serious harms) of WBRT, SRS, and systemic therapies for patients with brain metastases (either alone or in combination)?
• Discussion
  • Findings in Relation to the Decisional Dilemmas
  • Strengths and Limitations
  • Applicability
  • Implications for Clinical Practice, Education, Research, or Health Policy
  • Conclusions
• References
• Abbreviations and Acronyms
• Appendixes
  • Appendix A. Methods
  • Appendix B. List of Excluded Studies
  • Appendix C. Results
  • Appendix D. Evidence Table
  • Appendix E. Expert Guidance and Review
  • Appendix F. PCORI Checklist

Suggested citation:

Garsa A, Jang JK, Baxi S, Chen C, Akinniranye O, Hall O, Larkin J, Motala A, Newberry S, Hempel S. Radiation Therapy for Brain Metastases. Comparative Effectiveness Review No. 242. (Prepared by the Southern California Evidence-based Practice Center under Contract No. 290-2015-00001-I.) AHRQ Publication No. 21-EHC021. PCORI Publication No. 2020-SR-02. Rockville, MD: Agency for Healthcare Research and Quality; June 2021. DOI: https://doi.org/10.23970/AHRQEPCCER242, Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Southern California Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00010-I). The Patient-Centered Outcomes Research Institute^® (PCORI^®) funded the report (No. 2020-SR-02). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ or PCORI. Therefore, no statement in this report should be construed as an official position of PCORI, AHRQ, or the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

PCORI^®, AHRQ, or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Radiation Therapy for Brain Metastases, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).