Cochrane · systematic review · CD003869
Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases
Tsao, MN, Xu, W, Wong, RKS, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Gynaecological, Neuro-oncology and Orphan CancerAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
24
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 0 · 0%Moderate 15 · 62.5%High 9 · 37.5%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Altered WBRT fractionation schedules compared with WBRT control for treatment of newly diagnosed multiple brain metastases
Population: patients with newly diagnosed multiple brain metastases
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival: lower‐dose WBRT vs control WBRT (3000 cGy/10 daily fractions)No. of participants: 705(3 RCTs) Altered WBRT fractionation schedules vs WBRT control | HR 1.21 [1.04, 1.4] | NR | Moderate Downgraded: inconsistency |
Overall survival: higher‐dose WBRT vs control (3000 cGy/10 daily fractions)No. of participants: 846(4 RCTs) Altered WBRT fractionation schedules vs WBRT control | HR 0.97 [0.83, 1.12] | NR | Moderate Downgraded: inconsistency |
Overall survival: WBRT 4000 cGy/20 fractions BID vs control WBRT (2000 cGy/4‐5 daily fractions)No. of participants: 203(2 RCTs) Altered WBRT fractionation schedules vs WBRT control | HR 1.18 [0.89, 1.56] | NR | Moderate Downgraded: inconsistency |
Adverse effectsNo. of participants: 1754(9 RCTs) Altered WBRT fractionation schedules vs WBRT control | no estimate extracted | NR | High |
Symptom controlNo. of participants: 2877(7 RCTs) Altered WBRT fractionation schedules vs WBRT control | no estimate extracted | NR | Moderate Downgraded: risk of bias, inconsistency |
Overall brain controlNo. of participants: 203(2 RCTs) Altered WBRT fractionation schedules vs WBRT control | no estimate extracted | NR | Moderate Downgraded: risk of bias, inconsistency |
Altered WBRT fractionation schedules compared with WBRT control: neurological function improvement for treatment of newly diagnosed multiple brain metastases
Population: patients with newly diagnosed multiple brain metastases
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Neurological function improvement: lower‐dose WBRT vs control dose WBRT (3000 cGy/10 fractions)No. of participants: 1612(5 RCTs) Altered WBRT fractionation schedules vs WBRT control: neurological function improvement | OR 1.74 [1.06, 2.84] | NR | Moderate |
Neurological function improvement: higher‐dose WBRT vs control dose WBRT (3000 cGy/10 fractions)No. of participants: 1480(4 RCTs) Altered WBRT fractionation schedules vs WBRT control: neurological function improvement | OR 1.14 [0.92, 1.42] | NR | Moderate |
WBRT with radiosensitisers (radiosen) compared with WBRT alone for treatment of newly diagnosed multiple brain metastases
Population: patients with newly diagnosed multiple brain metastases
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survivalNo. of participants: 2631(8 RCTs) WBRT with radiosensitisers (radiosen) vs WBRT alone | HR 1.05 [0.99, 1.12] | NR | Moderate Downgraded: inconsistency |
Brain tumour response rates: complete response (CR) and partial response (PR) combinedNo. of participants: 847(6 RCTs) WBRT with radiosensitisers (radiosen) vs WBRT alone | OR 0.84 [0.63, 1.11] | NR | High |
Adverse effectsNo. of participants: 2631(8 RCTs) WBRT with radiosensitisers (radiosen) vs WBRT alone | no estimate extracted | NR | High |
Quality of lifeNo. of participants: 966(3 RCTs) WBRT with radiosensitisers (radiosen) vs WBRT alone | no estimate extracted | NR | Moderate Downgraded: risk of bias, inconsistency |
Symptom controlNo. of participants: 1814(3 RCTs) WBRT with radiosensitisers (radiosen) vs WBRT alone | no estimate extracted | NR | Moderate Downgraded: risk of bias, inconsistency |
WBRT and radiosurgery compared with WBRT for treatment of newly diagnosed multiple brain metastases
Population: patients with newly diagnosed multiple brain metastases
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survivalNo. of participants: 358(2 RCTs) WBRT and radiosurgery vs WBRT | HR 0.61 [0.27, 1.39] | NR | Moderate Downgraded: inconsistency |
1‐Year overall brain control ratesNo. of participants: 400(3 RCTs) WBRT and radiosurgery vs WBRT | HR 0.39 [0.25, 0.6] | NR | High |
Adverse effectsNo. of participants: 400(3 RCTs) WBRT and radiosurgery vs WBRT | no estimate extracted | NR | High |
Intracranial progression‐free durationNo. of participants: 400(3 RCTs) WBRT and radiosurgery vs WBRT | no estimate extracted | NR | High |
Radiosurgery alone compared with WBRT and radiosurgery for treatment of newly diagnosed multiple brain metastases
Population: patients with newly diagnosed multiple brain metastases
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survivalNo. of participants: 403(3 RCTs) Radiosurgery alone vs WBRT and radiosurgery | HR 1 [0.8, 1.25] | NR | Moderate Downgraded: inconsistency |
1‐Year radiosurgery‐targeted lesion controlNo. of participants: 602(4 RCTs) Radiosurgery alone vs WBRT and radiosurgery | HR 2.73 [1.87, 3.99] | NR | High |
1‐Year distant brain controlNo. of participants: 602(4 RCTs) Radiosurgery alone vs WBRT and radiosurgery | HR 2.34 [1.73, 3.18] | NR | High |
Adverse effectsNo. of participants: 602(4 RCTs) Radiosurgery alone vs WBRT and radiosurgery | no estimate extracted | NR | High |
NeurocognitionNo. of participants: 403(3 RCTs) Radiosurgery alone vs WBRT and radiosurgery | no estimate extracted | NR | Moderate Downgraded: risk of bias, inconsistency |
Neurological functionNo. of participants: 544(3 RCTs) Radiosurgery alone vs WBRT and radiosurgery | no estimate extracted | NR | Moderate Downgraded: risk of bias, inconsistency |
Quality of lifeNo. of participants: 271(2 RCTs) Radiosurgery alone vs WBRT and radiosurgery | no estimate extracted | NR | Moderate Downgraded: risk of bias, inconsistency |