Comparative Effectiveness Analysis of Treatment Options for Single Brain Metastasis

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• 作者：Kristopher T. Kimmell¹ ; ^{kristopher_kimmell@urmc.rochester.edu" class="auth_mail" title="E-mail the corresponding author} ; Emily LaSota² ; Robert J. Weil³ ; ; Nicholas F. Marko³
• 关键词：Comparative effectiveness research ; Cost ; Efficacy ; Karnofsky Performance Status ; Metastatic tumors ; Quality of life ; Single brain metastases ; Single metastasis
• 刊名：World Neurosurgery
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：84
• 期：5
• 页码：1316-1332
• 全文大小：20560 K

文摘

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.

Conclusion

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.