Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines Update for the Role of Emerging Therapies in the Management of Patients With Metastatic Brain Tumors.

Abstract

Background: Patients with metastatic brain tumors (MBTs) require a multidisciplinary team-based approach to select the best diagnostic, surgical, and radiation interventions.

Objective: The aim of this guideline was to provide an update of the evidence-based recommendations of the guideline produced in 2019 regarding the use of emerging therapies for adult patients with MBTs.

Methods: PubMed and Embase were searched from January 1, 2016, through May 3, 2022, using search strategies pertinent to the therapeutic topics: targeted agents, immune-modulating agents, interstitial modalities, radiosensitizers, laser interstitial thermal therapy, and magnetic resonance imaging-guided focused ultrasound. The search results were screened using pre-established exclusion/inclusion criteria. Evidence tables were constructed using these data, and the recommendations from the 2019 version were left unchanged, updated or, where appropriate, new recommendations were formulated.

Results: Of 6403 qualifying abstracts, 162 met the inclusion criteria and were included in the evidence tables. They provided 8 class I recommendations, 3 class II recommendations, and 17 class III recommendations. In three instances, there was insufficient evidence to support a recommendation. The proliferation of qualifying literature since the end of 2015 was greatest regarding the topics related to targeted therapy and immunotherapy of MBTs. Fewer were available for laser interstitial thermal therapy and radiosensitizers, but enough information was available to formulate recommendations on these two topics. For interstitial modalities and magnetic resonance imaging-guided focused ultrasound, insufficient qualifying data were identified to create recommendations.

Conclusion: This systematic review provides evidence-based recommendations for adult patients with MBTs regarding the use of therapies beyond standard surgical, radiation, and cytotoxic chemotherapy.