Anticonvulsant prophylaxis and steroid use in adults with metastatic brain tumors: summary of SNO and ASCO endorsement of the Congress of Neurological Surgeons guidelines

Susan M Chang; Hans Messersmith; Manmeet Ahluwalia; David Andrews; Priscilla K Brastianos; Laurie E Gaspar; Na Tosha N Gatson; Justin T Jordan; Mustafa Khasraw; Andrew B Lassman; Julia Maues; Maciej Mrugala; Jeffrey Raizer; David Schiff; Glen Stevens; Ashley Sumrall; Martin Van den Bent; Michael A Vogelbaum

doi:10.1093/neuonc/noz034

Anticonvulsant prophylaxis and steroid use in adults with metastatic brain tumors: summary of SNO and ASCO endorsement of the Congress of Neurological Surgeons guidelines

Neuro Oncol. 2019 Mar 18;21(4):424-427. doi: 10.1093/neuonc/noz034.

Authors

Susan M Chang¹, Hans Messersmith², Manmeet Ahluwalia³, David Andrews⁴, Priscilla K Brastianos⁵, Laurie E Gaspar⁶, Na Tosha N Gatson⁷, Justin T Jordan⁵, Mustafa Khasraw⁸, Andrew B Lassman⁹, Julia Maues¹⁰, Maciej Mrugala¹¹, Jeffrey Raizer¹², David Schiff¹³, Glen Stevens, Ashley Sumrall¹⁴, Martin Van den Bent¹⁵, Michael A Vogelbaum³

Affiliations

¹ University of California San Francisco, San Francisco, CA, USA.
² American Society of Clinical Oncology, Alexandria, VA, USA.
³ Cleveland Clinic, Cleveland, OH, USA.
⁴ Thomas Jefferson University, Philadelphia, PA, USA.
⁵ Massachusetts General Hospital, Boston, MA, USA.
⁶ University of Colorado School of Medicine, Denver, CO, USA.
⁷ Geisinger, Neuroscience & Cancer Institutes, Danville, PA, USA.
⁸ The University of Sydney, NSW, Australia.
⁹ Columbia University Irving Medical Center, New York, NY, USA.
¹⁰ Georgetown Breast Cancer Advocates, Washington, DC, USA.
¹¹ Mayo Clinic Phoenix, Phoenix, AZ, USA.
¹² Northwestern University, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
¹³ University of Virginia Medical Center, Charlottesville, VA, USA.
¹⁴ Levine Cancer Institute, Charlotte, NC, USA.
¹⁵ Erasmus MC Cancer Institute, Rotterdam, Netherlands.

Abstract

Background: The Congress of Neurological Surgeons (CNS) has developed a series of guidelines on the treatment of adults with metastatic brain tumors, including systemic therapy and supportive care topics. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.

Methods: Two CNS Guidelines were reviewed for developmental rigor by methodologists and an independent multi-disciplinary Expert Panel was formed to review the content and assess agreement with the recommendations. The expert panel voted to endorse the two guidelines and ASCO and SNO independently reviewed and approved the ASCO/SNO guideline endorsement.

Results: The ASCO/SNO Expert Panel determined that the recommendations from the CNS anticonvulsants and steroids guidelines, published January 9, 2019, are clear, thorough, and based upon the most relevant scientific evidence. ASCO/SNO endorsed these two CNS guidelines, with minor alterations.

Conclusions: Key recommendations include: prophylactic anti-epileptic drugs were not recommended for routine use; corticosteroids (specifically dexamethasone) were recommended for temporary symptomatic relief in patients with neurologic symptoms and signs related to mass effect from brain metastases.

© 2019. Society for Neuro-Oncology and the American Society of Clinical Oncology. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. This summary guideline endorsement was developed jointly by the Society for Neuro-Oncology & the American Society of Clinical Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

MeSH terms

Adrenal Cortex Hormones / therapeutic use*
Adult
Anticonvulsants / therapeutic use*
Brain Neoplasms / drug therapy*
Brain Neoplasms / secondary*
Female
Humans
Male
Practice Guidelines as Topic / standards*

Substances

Adrenal Cortex Hormones
Anticonvulsants