James Neurosurgeon Helps Draft Treatment Guidelines  

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Posted: 11/19/2009

COLUMBUS, Ohio – Dr. Mario Ammirati director of stereotactic neurosurgery and skull base surgery at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James), was part of a 20-member panel that drafted the first national evidence-based, multidisciplinary treatment guidelines for brain metastases patients. This significant new tool will improve the quality of care for patients who suffer from brain metastases.

The guidelines – which were released at the Congress of Neurological Surgeons 2009 Annual Meeting in New Orleans – were developed over the last year by a 20-member panel in various specialties in conjunction with the McMaster Evidence-based Practice Center in Ontario, Canada. The center is one of three designated by the Agency for Health Research and Quality of the U.S. Department of Health and Human Services that is located outside the United States.

The panel was formed by the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), which are the two largest scientific and educational associations for neurosurgical professionals in the world, representing approximately 7,600 neurosurgeons worldwide.

Members of the panel analyzed 25,000 studies and then utilized 400 of them to make their final guideline decisions. Ammirati, professor of neurosurgery and radiation oncology at OSUCCC-James, was actively involved in the development of these important guidelines.

“While 10-15 years ago the diagnosis of brain metastases was accompanied by a universally grim prognosis, we may now give hope to these patients. The new guidelines will provide a more evidence-based way of looking at the different options available to patients with brain metastases,” said Ammirati.

The formal evidence-based medicine process involved reviewing the literature and reaching a multidisciplinary consensus for different treatments. Unlike previous formal expert consensus efforts, recommendations are directly linked to levels of evidence in a transparent and reproducible methodology.

Brain metastases, which account for nearly 500,000 new cancers annually in the United States, are tumors which travel to the brain from other areas of the body, usually the breast or lung.

The new brain metastases guidelines include:

  • A range of therapeutic options for treating brain metastases.

  • The existing evidence used to guide decision-making and its limitations.

  • The range of diversity in practice patterns and the various demographic factors that influence clinical decisions.

  • The impact of expert reviews of published clinical evidence on practice regarding treatment options for brain metastases.

These strict evidence-based guidelines were also endorsed by the AANS/CNS Joint Tumor Section, as well as by experts from a wide range of multidisciplinary fields, including radiation oncology, medical oncology and neuro-oncology, and neurosurgery.

“Surgery, radiosurgery, localized brain radiation, whole brain radiation, chemotherapy and a combination of those have been used to treat patients with brain metastases,” said Ammirati, who specializes in radiosurgery, a non-invasive procedure in which high doses of radiation are delivered to tumors and vascular abnormalities deep within the brain. “The aim of these new guidelines is to identify best treatment practices leading to the best outcomes for patients.”

In cases where there was not enough data to suggest a guideline or recommendation for a particular treatment, all relevant ongoing clinical trials were listed in the report, as well as needed future studies.

“Some of these clinical trials are being conducted at The James,” said Ammirati. “We included these clinical trials to inform the medical community and to foster support for continuing this important research.”

The new guidelines will be published in a special issue of the Journal of Neuro-Oncology in December.

The Ohio State University Comprehensive Cancer Center- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute is one of only 40 Comprehensive Cancer Centers in the United States designated by the National Cancer Institute. Ranked by U.S. News & World Report among the top 20 cancer hospitals in the nation, The James (www.jamesline.com) is the 180-bed adult patient-care component of the cancer program at The Ohio State University. The OSUCCC-James is one of only five centers in the country approved by the NCI to conduct both Phase I and Phase II clinical trials.

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Eileen Scahill
Medical Center Communications

Tags: Brain Cancer; Cancer; James Cancer Hospital; Neurology; Neurosurgery; OSU Medical Center; Researchers

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) 460 W. 10th Avenue, Columbus, OH 43210 Phone: 1-800-293-5066 | Email: jamesline@osumc.edu