Evidence map›Paper›PMID 32780818›Full record

ArticleNeuro-oncology2020

Executive summary from American Radium Society's appropriate use criteria on neurocognition after stereotactic radiosurgery for multiple brain metastases.

Michael T Milano, Veronica L S Chiang, Scott G Soltys, Tony J C Wang, Simon S Lo, Alexandria Brackett, Seema Nagpal, Samuel Chao, Amit K Garg, Siavash Jabbari and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neuro-oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Review
  9. Observational
  10. Review
  11. Article
  12. Article
  13. Article
  14. Review
  15. Article
  16. Article
  17. Review
  18. Article
  19. Review
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Michael T MilanoDepartment of Radiation Oncology, University of Rochester, Rochester, NY.
Veronica L S ChiangDepartment of Neurosurgery, Yale School of Medicine, Yale University, New Haven, CT.
Scott G SoltysDepartment of Radiation Oncology, Stanford University Medical Center, Stanford, CT.
Tony J C WangDepartment of Radiation Oncology, Columbia University Irving Medical Center, New York, NY.
Simon S LoDepartment of Radiation Oncology, University of Washington, Seattle, WA.
Alexandria BrackettCushing/Whitney Medical Library, Yale School of Medicine, Yale University, New Haven, CT.
Seema NagpalDepartment of Neurology, Stanford University School of Medicine, Stanford, CT.
Samuel ChaoDepartment of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
Amit K GargDepartment of Radiation Oncology, University of Texas MD Anderson Cancer Center, Albuquerque, NM.
Siavash JabbariLaurel Amtower Cancer Institute and Neuro-oncology Center, Sharp Healthcare, San Diego, CA.
Lia M HalaszDepartment of Radiation Oncology, University of Washington, Seattle, WA.
Melanie Hayden GephartDepartment of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
Jonathan P S KniselyDepartment of Radiation Oncology, Weill Cornell Medicine, Cornell University, New York, NY.
Arjun SahgalDepartment of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Eric L ChangDepartment of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, CA.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
NCATS NIH HHS UL1 TR001863
6 · The paper itself

Abstract

backgroundThe American Radium Society (ARS) Appropriate Use Criteria brain malignancies panel systematically reviewed (PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses]) published literature on neurocognitive outcomes after stereotactic radiosurgery (SRS) for patients with multiple brain metastases (BM) to generate consensus guidelines.

methodsThe panel developed 4 key questions (KQs) to guide systematic review. From 11 614 original articles, 12 were selected. The panel developed model cases addressing KQs and potentially controversial scenarios not addressed in the systematic review (which might inform future ARS projects). Based upon quality of evidence, the panel confidentially voted on treatment options using a 9-point scale of appropriateness.

resultsThe panel agreed that SRS alone is usually appropriate for those with good performance status and 2-10 asymptomatic BM, and usually not appropriate for >20 BM. For 11-15 and 16-20 BM there was (between 2 case variants) agreement that SRS alone may be appropriate or disagreement on the appropriateness of SRS alone. There was no scenario (among 6 case variants) in which conventional whole-brain radiotherapy (WBRT) was considered usually appropriate by most panelists. There were several areas of disagreement, including: hippocampal sparing WBRT for 2-4 asymptomatic BM; WBRT for resected BM amenable to SRS; fractionated versus single-fraction SRS for resected BM, larger targets, and/or brainstem metastases; optimal treatment (WBRT, hippocampal sparing WBRT, SRS alone to all or select lesions) for patients with progressive extracranial disease, poor performance status, and no systemic options.

conclusionsFor patients with 2-10 BM, SRS alone is an appropriate treatment option for well-selected patients with good performance status. Future study is needed for those scenarios in which there was disagreement among panelists.

Indexed as

Brain NeoplasmsRadiosurgeryRadiumCranial IrradiationHumansSystematic Reviews as TopicUnited StatesRadiumbrain metastasesconsensus guidelinesneurocognitionstereotactic radiosurgerysystematic review

Identifiers

PMID32780818
PMCPMC7746939

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.