Guideline Title
Brain metastases.
Bibliographic Source(s)
Guideline Status
This is the current release of the guideline. This guideline updates a previous version: Soffietti R, Cornu P, Delattre JY, Grant R, Graus F, Grisold W, Heimans J, Hildebrand J, Hoskin P, Kalljo M, Krauseneck P, Marosi C, Siegal T, Vecht C. EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 2006 Jul;13(7):674-81. |
|
Scope
Disease/Condition(s)
Brain metastases
Guideline Category
Diagnosis
Evaluation Management Treatment
Clinical Specialty
Family Practice
Internal Medicine Neurological Surgery Neurology Oncology Radiation Oncology
Intended Users
Physicians
Guideline Objective(s)
Target Population
Patients with brain metastases
Interventions and Practices Considered
Diagnosis/Evaluation
Management/Treatment
Major Outcomes Considered
|
|
Methodology
Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
The task force members searched the following databases: the Cochrane Library to date; Medline–Ovid (January 1966 to date); Medline–ProQuest; Medline-EIFL; EMBASE–Ovid (January 1990 to date); CancerNet; Science Citation Index (ISI). They used specific and sensitive keywords, as well as combinations of keywords, and publications in any language of countries represented in the task force. The task force members also collected guidelines from national and European multidisciplinary neuro-oncological societies and groups (from Italy, France, Netherlands, Germany, and the UK). Moreover, they performed an investigation (by e-mail questionnaire) regarding the views of members of the task force on several critical issues, reflecting the different national situations (10 countries) and specializations (11 neurologists, one neurosurgeon, one radiation oncologist, and one medical oncologist).
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Evidence Classification Scheme for a Diagnostic Measure Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a 'gold standard' for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by 'gold standard') compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy Class III: Evidence provided by a retrospective study where either persons with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls) Evidence Classification Scheme for a Therapeutic Intervention Class I: An adequately powered prospective, randomized, controlled clinical trial with masked outcome assessment in a representative population or an adequately powered systematic review of prospective randomized controlled clinical trials with masked outcome assessment in representative populations. The following are required:
Class II: Prospective matched-group cohort study in a representative population with masked outcome assessment that meets a–e above or a randomized, controlled trial in a representative population that lacks one criteria a–e Class III: All other controlled trials (including well-defined natural history controls or patients serving as own controls) in a representative population, where outcome assessment is independent of patient treatment Class IV: Evidence from uncontrolled studies, case series, case reports, or expert opinion
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review
Description of the Methods Used to Analyze the Evidence
The scientific evidence of papers collected from the literature was evaluated and graded according to European Federation of Neurological Societies (EFNS) Guidelines (see the "Availability of Companion Documents" field).
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
The scientific evidence of papers collected from the literature was evaluated and graded according to European Federation of Neurological Societies (EFNS) Guidelines, and recommendations were given according to the same paper (see the "Availability of Companion Documents" field). When sufficient evidence for recommendations A–C was not available, the task force considered a recommendation to be a 'Good Practice Point' (GPP) if agreed by all members of the task force. When analyzing results and drawing recommendations, at any stage the differences were resolved by discussions.
Rating Scheme for the Strength of the Recommendations
Rating of Recommendations for a Diagnostic Measure Level A rating (established as useful/predictive or not useful/predictive) requires at least one convincing class I study or at least two consistent, convincing class II studies. Level B rating (established as probably useful/predictive or not useful/predictive) requires at least one convincing class II study or overwhelming class III evidence. Level C rating (established as possibly useful/predictive or not useful/predictive) requires at least two convincing class III studies. Rating of Recommendations for a Therapeutic Intervention Level A rating (established as effective, ineffective, or harmful) requires at least one convincing class I study or at least two consistent, convincing class II studies. Level B rating (probably effective, ineffective, or harmful) requires at least one convincing class II study or overwhelming class III evidence. Level C rating (possibly effective, ineffective, or harmful) requires at least two convincing class III studies. Good Practice Point When sufficient evidence for recommendations A–C was not available, the task force considered a recommendation to be a 'Good Practice Point' if agreed by all members of the task force.
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
The guidelines were validated according to the European Federation of Neurological Societies (EFNS) criteria (see the "Availability of Companion Documents" field). |
|
Recommendations
Major Recommendations
The levels of evidence (Class I-IV) supporting the recommendations and ratings of recommendations (A-C, Good Practice Point [GPP]) are defined at the end of the "Major Recommendations" field. Diagnosis
Supportive Care
Treatment of Single Brain Metastasis
Treatment of Multiple Brain Metastases
Chemotherapy
Targeted Therapies
Definitions: Evidence Classification Scheme for a Diagnostic Measure Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a 'gold standard' for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by 'gold standard') compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy Class III: Evidence provided by a retrospective study where either persons with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls) Evidence Classification Scheme for a Therapeutic Intervention Class I: An adequately powered prospective, randomized, controlled clinical trial with masked outcome assessment in a representative population or an adequately powered systematic review of prospective randomized controlled clinical trials with masked outcome assessment in representative populations. The following are required:
Class II: Prospective matched-group cohort study in a representative population with masked outcome assessment that meets a–e above or a randomized, controlled trial in a representative population that lacks one criteria a–e Class III: All other controlled trials (including well-defined natural history controls or patients serving as own controls) in a representative population, where outcome assessment is independent of patient treatment Class IV: Evidence from uncontrolled studies, case series, case reports, or expert opinion Rating of Recommendations for a Diagnostic Measure Level A rating (established as useful/predictive or not useful/predictive) requires at least one convincing class I study or at least two consistent, convincing class II studies. Level B rating (established as probably useful/predictive or not useful/predictive) requires at least one convincing class II study or overwhelming class III evidence. Level C rating (established as possibly useful/predictive or not useful/predictive) requires at least two convincing class III studies. Rating of Recommendations for a Therapeutic Intervention Level A rating (established as effective, ineffective, or harmful) requires at least one convincing class I study or at least two consistent, convincing class II studies. Level B rating (probably effective, ineffective, or harmful) requires at least one convincing class II study or overwhelming class III evidence. Level C rating (possibly effective, ineffective, or harmful) requires at least two convincing class III studies. Good Practice Point When sufficient evidence for recommendations A–C was not available, the task force considered a recommendation to be a 'Good Practice Point' if agreed by all members of the task force.
Clinical Algorithm(s)
None provided |
|
Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field). |
|
Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
Appropriate diagnosis and treatment of brain metastases
Potential Harms
|
|
Contraindications
Contraindications
In patients who suffer from epileptic seizures and need a concomitant treatment with chemotherapeutics, enzyme-inducing antiepileptic drugs (EIAEDs) should be avoided. |
|
Qualifying Statements
Qualifying Statements
This guideline provides the view of an expert task force appointed by the Scientific Committee of the European Federation of Neurological Societies (EFNS). It represents a peer-reviewed statement of minimum desirable standards for the guidance of practice based on the best available evidence. It is not intended to have legally binding implications in individual cases. |
|
Implementation of the Guideline
Description of Implementation Strategy
The European Federation of Neurological Societies has a mailing list, and all guideline papers go to national societies, national ministries of health, World Health Organisation, European Union, and a number of other destinations. Corporate support is recruited to buy large numbers of reprints of the guideline papers and permission is given to sponsoring companies to distribute the guideline papers from their commercial channels, provided there is no advertising attached. |
|
Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
|
|
Identifying Information and Availability
Bibliographic Source(s)
Adaptation
Not applicable: The guideline was not adapted from another source.
Date Released
2006 Jul (revised 2011)
Guideline Developer(s)
European Academy of Neurology - Medical Specialty Society
Source(s) of Funding
European Federation of Neurological Societies
Guideline Committee
European Federation of Neurological Societies Task Force on Brain Metastases
Composition of Group That Authored the Guideline
Task Force Members: R. Soffietti, San Giovanni Battista Hospital and University, Torino, Italy; P. Cornu, Pitié-Salpétrière and University, Paris, France; J. Y. Delattre, Pitié-Salpétrière, Paris, France; R. Grant, Western General Hospital and University, Edinburgh, UK; F. Graus, Hospital Clinic, Villaroel, Barcelona, Spain; W. Grisold, Kaiser-Franz-Josef Spital, Vienna, Austria; J. Heimans, Academisch Ziekenhuis V.U., Amsterdam, The Netherlands; J. Hildebrand, Brussels, Belgium; P. Hoskin, Mount Vernon Hospital and University, Northwood, Middlesex, UK; M. Kalljo, University Hospital, Helsinki, Finland; P. Krauseneck, Neurologische Clinic, Bamberg, Germany; C. Marosi, Vienna General Hospital and University, Vienna, Austria; T. Siegal, Hadassah Hebrew University, Jerusalem, Israel; C. Vecht, Med Center Haaglanden, The Hague, The Netherlands
Financial Disclosures/Conflicts of Interest
None of the members of the Task Force, including the chairperson, had any form of conflict of interest.
Guideline Status
This is the current release of the guideline. This guideline updates a previous version: Soffietti R, Cornu P, Delattre JY, Grant R, Graus F, Grisold W, Heimans J, Hildebrand J, Hoskin P, Kalljo M, Krauseneck P, Marosi C, Siegal T, Vecht C. EFNS Guidelines on diagnosis and treatment of brain metastases: report of an EFNS Task Force. Eur J Neurol 2006 Jul;13(7):674-81.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the European Federation of Neurological Societies (EFNS) Web site .
Availability of Companion Documents
The following is available:
Patient Resources
None available
NGC Status
This NGC summary was completed by ECRI on April 6, 2007. The information was verified by the guideline developer on May 25, 2007. This summary was updated by ECRI Institute on June 26, 2007 following the U.S. Food and Drug Administration (FDA) advisory on heparin sodium injection. This summary was updated by ECRI Institute on March 14, 2008 following the updated FDA advisory on heparin sodium injection. This summary was updated by ECRI Institute on December 26, 2008 following the FDA advisory on Innohep (tinzaparin). This summary was updated by ECRI Institute on February 20, 2012. This summary was updated by ECRI Institute on March 10, 2014 following the U.S. Food and Drug Administration advisory on Low Molecular Weight Heparins.
Copyright Statement
This NGC summary is based on the original guideline, which is subject to the Blackwell-Synergy copyright restrictions. |
|
Disclaimer
NGC Disclaimer
The National Guideline Clearinghouseâ„¢ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site. All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities. Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion-criteria.aspx. NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes. Readers with questions regarding guideline content are directed to contact the guideline developer. |