Critical appraisal:Bates JE, Youn P, Usuki KY, Walter KA, Huggins CF, Okunieff P, et al 2015

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Critical Appraisal

Article being appraised

Bates JE, Youn P, Usuki KY, Walter KA, Huggins CF, Okunieff P, et al. Brain metastasis from melanoma: the prognostic value of varying sites of extracranial disease. J Neurooncol 2015 Nov;125(2):411-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26354772.


Applicable clinical question

Key Facts

Study Design

cohort study

Study aims:

To further characterise the role of SRS and/or WBRT in patients with brain-metastatic melanoma in a retrospective manner based on the experience of a single major academic medical institution.

Number of Patients:

73

Fourteen (19.2%) patients receieved SRS alone, 39 (53.4%) received WBRT alone, and 20 (27.4%) received both SRS and WBRT.
Reported outcome(s):

Overall survival (OS), progression free survival (PFS), brain progression free survival (BPFS)

Results of outcome(s):

The median overall survival (OS) for this cohort was 3 months.
Patients with three or more distinct sites of intracranial disease (n=39, OS= 1.8 months, HR= 1.98, p= 0.005) did significantly worse than those with one or two sites of intracranial disease (n= 34, OS= 7 months).
Patients who received SRS alone (OS= 11.9 months, HR= 0.38, 95% CI 0.21-0.68, p= 0.001) or SRS and WBRT (OS= 3.8 months, HR= 0.51, 95%CI 0.27-0.97, p= 0.04) had improved OS compared to those who received WBRT alone (OS= 1.9 months).

Those patients who received SRS alone (BPFS= 4.0 months, HR= 0.53, 95%CI 0.30-0.91, p= 0.02) had improved BPFS, compared to those who received WBRT alone (BPFS= 1.4 months), while those who received SRS + WBRT (BPFS= 3.2 months, HR= 0.61, 95%CI 0.32-1.16, p= 0.13) had no significant change in BPFS.

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: Please replace this text and include any additional comments in regards to your risk of bias rating

Risk of bias assessment: cohort study

Subject selection
"New technology" group
Selected group
Comparison group
Selected group
Comparability of groups on demographic characteristics and clinical features
Not comparable and not adjusted for differences
Measurement of outcomes
Outcome measures blind to technology used
No, but objective measures used
Same method of measurement used across comparison groups
Yes
Completeness of follow-up
Was follow-up complete and were all patients included in the analysis?
Yes (follow-up >95%) or survival analysis using all patients
Result of appraisal

Jutta's tick icon.png Included




Completed by

Tamsin Parrish


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Article
Bates JE, Youn P, Usuki KY, Walter KA, Huggins CF, Okunieff P, et al. Brain metastasis from melanoma: the prognostic value of varying sites of extracranial disease. J Neurooncol 2015 Nov;125(2):411-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26354772.
Assigned to
User:Tamsin.parrish
Topic area
Guidelines:Melanoma
Clinical question
Form
Form:Critical appraisal


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