title: The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.
abstract: METHODS
  This recommendation applies to adults with newly diagnosed brain metastases; however, the recommendation below does not apply to the exquisitely chemosensitive tumors, such as germinomas metastatic to the brain.
  
  
  CONCLUSIONS
  Should patients with brain metastases receive chemotherapy in addition to whole brain radiotherapy (WBRT)? Level 1 Routine use of chemotherapy following WBRT for brain metastases has not been shown to increase survival and is not recommended. Four class I studies examined the role of carboplatin, chloroethylnitrosoureas, tegafur and temozolomide, and all resulted in no survival benefit. Two caveats are provided in order to allow the treating physician to individualize decision-making: First, the majority of the data are limited to non small cell lung (NSCLC) and breast cancer; therefore, in other tumor histologies, the possibility of clinical benefit cannot be absolutely ruled out. Second, the addition of chemotherapy to WBRT improved response rates in some, but not all trials; response rate was not the primary endpoint in most of these trials and end-point assessment was non-centralized, non-blinded, and post-hoc. Enrollment in chemotherapy-related clinical trials is encouraged.
authors: Department of Human Oncology, University of Wisconsin School of Public Health and Medicine, Madison, WI, USA.
authors: Minesh P
authors: MP
authors: Mehta
authors: Nina A
authors: NA
authors: Paleologos
authors: Tom
authors: T
authors: Mikkelsen
authors: Paula D
authors: PD
authors: Robinson
authors: Mario
authors: M
authors: Ammirati
authors: David W
authors: DW
authors: Andrews
authors: Anthony L
authors: AL
authors: Asher
authors: Stuart H
authors: SH
authors: Burri
authors: Charles S
authors: CS
authors: Cobbs
authors: Laurie E
authors: LE
authors: Gaspar
authors: Douglas
authors: D
authors: Kondziolka
authors: Mark E
authors: ME
authors: Linskey
authors: Jay S
authors: JS
authors: Loeffler
authors: Michael
authors: M
authors: McDermott
authors: Jeffrey J
authors: JJ
authors: Olson
authors: Roy A
authors: RA
authors: Patchell
authors: Timothy C
authors: TC
authors: Ryken
authors: Steven N
authors: SN
authors: Kalkanis
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000556:secondary; D004358:Drug Therapy / Q000379:methods* / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic