title: Comparative Effectiveness Analysis of Treatment Options for Single Brain Metastasis.
abstract: BACKGROUND
  Brain metastases (BMs) occur in up to 30% of patients with cancer. Treatments include surgery, whole-brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS), alone or in combination. Although guidelines exist, data to inform individualized approaches to therapy remain sparse. We sought to compare semiquantitatively the effectiveness of various modalities in the treatment of single brain metastasis.
  
  
  METHODS
  We performed a comparative effectiveness analysis (CEA) that integrated efficacy, cost, and quality of life (QoL) data for alternate BM treatments. Efficacy data were obtained from a comprehensive review of current literature. Cost estimates were based on publicly available data. QoL data included the Karnofsky Performance Status (KPS) and other questionnaires. Six treatment strategies using combinations of surgery, WBRT, and SRS were compared with decision tree software.
  
  
  RESULTS
  The clinical efficacy, cost, and QoL effects of each strategy were scored semiquantitatively. We constructed a model to integrate individual preferences regarding the relative importance of efficacy, QoL, and cost to provide personalized rankings of the effectiveness of each strategy.
  
  
  CONCLUSIONS
  The choice of strategy must be individualized for patients with a single BM. Our CEA and decision model combines empirical data with patient priorities to produce a ranking of alternate management strategies.
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA. Electronic address: kristopher_kimmell@urmc.rochester.edu.
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kimmell
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: LaSota
authors.affiliation: Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
authors.affiliation: Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Marko
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D016371:Cranial Irradiation; D003661:Decision Support Techniques; D006801:Humans; D017567:Karnofsky Performance Status; D019635:Neurosurgical Procedures / Q000191:economics / Q000379:methods*; D057285:Precision Medicine; D011788:Quality of Life; D016634:Radiosurgery / Q000191:economics / Q000379:methods*; D016879:Salvage Therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Comparative effectiveness research; Cost; Efficacy; Karnofsky Performance Status; Metastatic tumors; Quality of life; Single brain metastases; Single metastasis