Controversies about treatment of brain metastasis: multicenter survey
Keywords:
Encephalic neoplasms, Health knowledge, aptitudes and practices, Neoplasm metastasis, Neurology, Neurosurgery, RadiosurgeryAbstract
OBJECTIVE: To explore some opinions about handling of brain metastases as well as the decisions taking in punctual cases in a group of neurosurgeons, neurologists, radiotherapeutics and oncologists.
METHODS: It was carried out an exploratory study based in survey application to neurosurgeons, neurologists, radiotherapeutics and oncologists group. Opinions about treatment options in patients with brain metastases and treatment option selected in four problem cases were evaluated. The biggest number of brain metastases considered as reasonable to treat with radiosurgery and whole brain radiation therapy were tabulated. Also, the percent of test used to assess neurocognitive damage was determined.
RESULTS: 45 interviewed (62 %) would not send patient to neurosurgery; 22 interviewed (30 %) would not send patient to oncologists; 30 interviewed (41 %) would send the patient directly at the radiotherapeutics, and 19 interviewed (26 %) would not send patient to neurooncologists. Only 7 interviewed (10 %) would send patients to all the specialties with statistical significance (p=0.001). About the use of whole brain radiation therapy like therapeutic modality, 52 interviewed (71 %) considered that their use should be carried out in precise indications. In contrast, 12 specialists (16 %) declared that it should be used in all cases. Current study showed preference of neurosurgeons than oncologists and radiotherapeutics to indicate radiosurgery. 38 interviewed (52 %) ignore some tests used to assess neurocognitive damage and 6 % interviewed would indicate none.
CONCLUSIONS: Discrepancies among specialties to select best treatment modality and some positions don't correspond to current scientific evidence regarding brain metastasis management. We also intend to design future studies that involve all regions of the country for to obtaining more precise scientific evidence.
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References
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