Journal article
ACR Appropriateness Criteria® Pre-Irradiation Evaluation and Management of Brain Metastases
Journal of palliative medicine, Vol.17(8), pp.88-886
08/01/2014
DOI: 10.1089/jpm.2014.9417
PMCID: PMC4275774
PMID: 24971478
Abstract
Pretreatment evaluation is performed to determine the number, location, and size of the brain metastases and magnetic resonance imaging (MRI) is the recommended imaging technique, particularly in patients being considered for surgery or stereotactic radiosurgery. A contiguous thin-cut volumetric MRI with gadolinium with newer gadolinium-based agents can improve detection of small brain metastases. A systemic workup and medical evaluation are important, given that subsequent treatment for the brain metastases will also depend on the extent of the extracranial disease and on the age and performance status of the patient. Patients with hydrocephalus or impending brain herniation should be started on high doses of corticosteroids and evaluated for possible neurosurgical intervention. Patients with moderate symptoms should receive approximately 4–8 mg/d of dexamethasone in divided doses. The routine use of corticosteroids in patients without neurologic symptoms is not necessary. There is no proven benefit of anticonvulsants in patient without seizures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Details
- Title: Subtitle
- ACR Appropriateness Criteria® Pre-Irradiation Evaluation and Management of Brain Metastases
- Creators
- Simon Shek-Man Lo - 1UH Seidman Cancer Center, Cleveland, OhioElizabeth M Gore - 2Medical College of Wisconsin, Milwaukee, WisconsinJeffrey D Bradley - 3Washington University School of Medicine, St. Louis, MissouriJohn M Buatti - 4University of Iowa Hospital, Iowa City, IowaIsabelle Germano - 5Mount Sinai School of Medicine, New York, New York, American Association of Neurological Surgeons/Congress of Neurological SurgeonsA. Paiman Ghafoori - 6University Medical Center Brackenridge, Austin, TexasMark A Henderson - 7Indiana University School of Medicine, Indianapolis, IndianaGregory J.A Murad - 8University of Florida, Gainesville, Florida, American Association of Neurological Surgeons/Congress of Neurological SurgeonsRoy A Patchell - 9Capital Health Medical Center-Hopewell, Pennington, New Jersey, American Academy of NeurologySamir H Patel - 10Mayo Clinic Arizona, Scottsdale, ArizonaJared R Robbins - 11Henry Ford Hospital, Detroit, MichiganH. Ian Robins - 12University of Wisconsin, Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, American Society of Clinical OncologyAndrew D Vassil - 13Clevelend Clinic, Strongsville, OhioFranz J Wippold - 14Mallinckrodt Institute of Radiology, Saint Louis, Missouri, Chair, Expert Panel on Neurologic ImagingMichael J Yunes - 15Baystate Medical Center, Springfield, MassachusettsGregory M.M Videtic - 16Cleveland Clinic Foundation, Cleveland, Ohio
- Resource Type
- Journal article
- Publication Details
- Journal of palliative medicine, Vol.17(8), pp.88-886
- Publisher
- Mary Ann Liebert, Inc
- DOI
- 10.1089/jpm.2014.9417
- PMID
- 24971478
- PMCID
- PMC4275774
- ISSN
- 1096-6218
- eISSN
- 1557-7740
- Language
- English
- Date published
- 08/01/2014
- Academic Unit
- Radiation Oncology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040001602771
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