MethodsSystematic review
Participants and CountryStudies of patients with systemic cancer (primary site confirmed by histology) and a suspected single brain metastasis (on imaging and clinical findings) were included; the brain metastasis did not have to be histologically proven. Three RCTs were included in the review.
InterventionsSurgical resection and WBRT versus WBRT alone. Radiosurgery was not included.
OutcomesOverall survival There was no statistically significant difference in overall survival between the two treatment groups (HR = 0.72, 95% CI 0.34 to 1.53, P = 0.40). There was significant heterogeneity between the trials (I2 = 82%); two of the trials reported better survival in those undergoing surgery and WBRT while one reported better survival in patients receiving only WBRT.
Functionally independent survival Data about functionally independent survival could only be extracted from one trial. This trial found that those treated by surgery and WBRT maintained functional independence for longer than those treated by WBRT alone (HR = 0.42, 95% CI 0.22 to 0.82, P = 0.01).
Neurological death Patients treated with surgery were less likely to die from neurological causes (RR = 0.68 95% CI 0–43 to 1.09, P = 0.11), but this result was not statistically significant. Results were reasonably consistent between trials, with no significant heterogeneity.
Adverse events
Adverse events were not well reported, and it was unclear whether patients had experienced multiple adverse events. Allowing for this there was no significant difference in the adverse event rates of the two treatments (RR = 1.2795% CI = 0.77 to 2.09 P =0.35). However the confidence interval is wide, and it is possible that either of the treatments could cause significantly more adverse events than the other

From: Guideline chapter 4, Specific Presentations

Cover of Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin
Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin.
NICE Clinical Guidelines, No. 104.
National Collaborating Centre for Cancer (UK).
Copyright © 2010, National Collaborating Centre for Cancer.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licenses issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.