Supportive care management of brain metastases: what is known and what we need to know. Conference proceedings of the National Cancer Institute of Canada (NCIC) Workshop on Symptom Control in Radiation Oncology.
OBJECTIVE
To review the results of published randomised controlled trials in the treatment of brain metastases and, from the knowledge gained from these trials, to identify potential study questions.


METHODS
The literature was searched for randomised controlled trials that dealt with the management of brain metastases. Potential research questions were identified on the basis of the results of the literature review.


RESULTS
A number of research questions were identified. In the context of the NCIC Symptom Control Group, a trial of supportive care alone vs supportive care and whole-brain radiotherapy (WBRT) in a subset of patients with the diagnosis of brain metastases was deemed to be of highest priority. We discussed a number of issues relating to the feasibility of such a trial.


CONCLUSIONS
The optimal management of brain metastases remains elusive. Despite the results of numerous randomised controlled trials, many questions remain unanswered. The magnitude of benefit using WBRT above supportive care alone is uncertain. A trial of supportive care alone vs supportive care and WBRT may be successful once target population, feasibility and methodological issues are thoroughly solved.
Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Canada. may.tsao@tsrcc.on.ca
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MN
Tsao
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Sultanem
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Chiu
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Copps
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Dixon
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D
Easton
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Haddad
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C
Hayter
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Hoegler
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Wong
D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic