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Modern treatment of cerebral metastases: Integrated Medical LearningSM at CNS 2007

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Abstract

Introduction Cerebral metastases are a common problem and pose complex treatment decisions, with reference to local control of treated lesions, prevention of new brain metastases, and toxicity of available treatments. At the 2007 Congress of Neurological Surgeons (CNS) Annual Meeting, a novel active learning process, called Integrated Medical LearningSM, was used to better understand contemporary practice patterns and to monitor the success of education about these critical treatment decisions. Methods CNS members received an electronically distributed premeeting survey and educational materials about single and multiple cerebral metastasis treatment; practice patterns were elicited. At the Annual Meeting, 496 surgeons were polled using handheld devices before and after surgical and radiation oncology expert presentations. Surgeons who had answered premeeting surveys received a second, postmeeting questionnaire. Results In the premeeting questionnaire (N = 214), higher current volume of practice, Tumor Section membership, and academic practice predicted more correct answers (P < 0.05 for all). Fifty five percent favored routine whole brain radiotherapy (WBRT) after metastasis resection. Thirty four percent “most often” used radiosurgery to the resection bed; these respondents cited “cognitive changes” in justifying WBRT omission. At the meeting, expert presentations were followed by audience shifts toward adjuvant WBRT after resection (P = 0.01) or radiosurgery (P < 0.001)—topics for which class I evidence was discussed. There was no shift in preference for surgery or radiosurgery (P = 0.24) or multiple metastasis treatment (P = 0.8)—topics for which clear class I evidence was not presented. Postmeeting questionnaires showed retained knowledge among meeting attendees. Conclusions Using IML, we were able to study baseline knowledge and practice patterns for an important neuro-oncological treatment decision. Evidence suggested expert presentations were effective in changing audience opinion when relevant class I evidence was presented, and that knowledge was retained postmeeting.

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Acknowledgements

We gratefully acknowledge the assistance of many people without whom this research would not have been possible: Gerald E. Rodts, Jr., M.D.; Stephen B. Tatter, M.D., Ph.D.; Minesh P. Mehta, M.D.; Steven N. Kalkanis, M.D.; Frederick F. Lang, M.D.; David C. Berg and the staff of the Congress of Neurological Surgeons; and the staff of VisionTree Software, Inc.

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Authors and Affiliations

  1. Brain Tumor and Neuro-Oncology Center, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Michael A. Vogelbaum

  2. Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Michael A. Vogelbaum

  3. Brain Tumor Program, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA

    Anthony L. Asher

  4. Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Douglas Kondziolka

  5. Department of Neurological Surgery, Emory University, Atlanta, GA, USA

    Nicholas M. Boulis

  6. Division of Pediatric Neurosurgery, Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA

    Nathan R. Selden

  7. Department of Neurosurgery, University of Florida, Gainesville, FL, USA

    Brian L. Hoh

  8. Department of Surgery (Neurosurgery), Harvard Medical School, Boston, MA, USA

    Fred G. Barker II

  9. Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Yawkey 9E, Fruit Street, Boston, MA, 02114, USA

    Fred G. Barker II

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Michael A. Vogelbaum and Anthony L. Asher contributed equally to the manuscript.

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Vogelbaum, M.A., Asher, A.L., Kondziolka, D. et al. Modern treatment of cerebral metastases: Integrated Medical LearningSM at CNS 2007. J Neurooncol 93, 89–105 (2009). https://doi.org/10.1007/s11060-009-9833-4

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