Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine

M. Glatzer; C. Faivre-Finn; D. De Ruysscher; J. Widder; P. Van Houtte; E.G.C. Troost; B. Slotman; S. Ramella; C. Pottgen; S.T.H. Peeters; U. Nestle; F. McDonald; C. Le Pechoux; R. Dziadziuszko; J. Belderbos; U. Ricardi; F. Manapov; Y. Lievens; X. Geets; K. Dieckmann; M. Guckenberger; N. Andratschke; K. Suveg; P.M. Putora

doi:10.1016/j.radonc.2020.10.043

Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine

M. Glatzer^*, C. Faivre-Finn, D. De Ruysscher, J. Widder, P. Van Houtte, E.G.C. Troost, B. Slotman, S. Ramella, C. Pottgen, S.T.H. Peeters, U. Nestle, F. McDonald, C. Le Pechoux, R. Dziadziuszko, J. Belderbos, U. Ricardi, F. Manapov, Y. Lievens, X. Geets, K. DieckmannM. Guckenberger, N. Andratschke, K. Suveg, P.M. Putora

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Whole brain radiotherapy (WBRT) is a common treatment option for brain metastases secondary to non-small cell lung cancer (NSCLC). Data from the QUARTZ trial suggest that WBRT can be omitted in selected patients and treated with optimal supportive care alone. Nevertheless, WBRT is still widely used to treat brain metastases secondary to NSCLC. We analysed decision criteria influencing the selection for WBRT among European radiation oncology experts.Methods: Twenty-two European radiation oncology experts in lung cancer as selected by the European Society for Therapeutic Radiation Oncology (ESTRO) for previous projects and by the Advisory Committee on Radiation Oncology Practice (ACROP) for lung cancer were asked to describe their strategies in the management of brain metastases of NSCLC. Treatment strategies were subsequently converted into decision trees and analysed for agreement and discrepancies.Results: Eight decision criteria (suitability for SRS, performance status, symptoms, eligibility for targeted therapy, extra-cranial tumour control, age, prognostic scores and "Zugzwang" (the compulsion to treat)) were identified. WBRT was recommended by a majority of the European experts for symptomatic patients not suitable for radiosurgery or fractionated stereotactic radiotherapy. There was also a tendency to use WBRT in the ALK/EGFR/ROS1 negative NSCLC setting.Conclusion: Despite the results of the QUARTZ trial WBRT is still widely used among European radiation oncology experts. (C) 2020 Elsevier B.V. All rights reserved.

Original language	English
Pages (from-to)	269-273
Number of pages	5
Journal	Radiotherapy and Oncology
Volume	154
DOIs	https://doi.org/10.1016/j.radonc.2020.10.043
Publication status	Published - 1 Jan 2021

Keywords

ALGORITHMS
CELL LUNG-CANCER
Decision tree
Decision-making
MULTICENTER
NSCLC
PHASE-3
QUARTZ
STEREOTACTIC RADIOSURGERY
WBRT

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10.1016/j.radonc.2020.10.043

Cite this

Glatzer, M., Faivre-Finn, C., De Ruysscher, D., Widder, J., Van Houtte, P., Troost, E. G. C., Slotman, B., Ramella, S., Pottgen, C., Peeters, S. T. H., Nestle, U., McDonald, F., Le Pechoux, C., Dziadziuszko, R., Belderbos, J., Ricardi, U., Manapov, F., Lievens, Y., Geets, X., ... Putora, P. M. (2021). Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine. Radiotherapy and Oncology, 154, 269-273. https://doi.org/10.1016/j.radonc.2020.10.043

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title = "Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine",

abstract = "Background: Whole brain radiotherapy (WBRT) is a common treatment option for brain metastases secondary to non-small cell lung cancer (NSCLC). Data from the QUARTZ trial suggest that WBRT can be omitted in selected patients and treated with optimal supportive care alone. Nevertheless, WBRT is still widely used to treat brain metastases secondary to NSCLC. We analysed decision criteria influencing the selection for WBRT among European radiation oncology experts.Methods: Twenty-two European radiation oncology experts in lung cancer as selected by the European Society for Therapeutic Radiation Oncology (ESTRO) for previous projects and by the Advisory Committee on Radiation Oncology Practice (ACROP) for lung cancer were asked to describe their strategies in the management of brain metastases of NSCLC. Treatment strategies were subsequently converted into decision trees and analysed for agreement and discrepancies.Results: Eight decision criteria (suitability for SRS, performance status, symptoms, eligibility for targeted therapy, extra-cranial tumour control, age, prognostic scores and {"}Zugzwang{"} (the compulsion to treat)) were identified. WBRT was recommended by a majority of the European experts for symptomatic patients not suitable for radiosurgery or fractionated stereotactic radiotherapy. There was also a tendency to use WBRT in the ALK/EGFR/ROS1 negative NSCLC setting.Conclusion: Despite the results of the QUARTZ trial WBRT is still widely used among European radiation oncology experts. (C) 2020 Elsevier B.V. All rights reserved.",

keywords = "ALGORITHMS, CELL LUNG-CANCER, Decision tree, Decision-making, MULTICENTER, NSCLC, PHASE-3, QUARTZ, STEREOTACTIC RADIOSURGERY, WBRT",

author = "M. Glatzer and C. Faivre-Finn and {De Ruysscher}, D. and J. Widder and {Van Houtte}, P. and E.G.C. Troost and B. Slotman and S. Ramella and C. Pottgen and S.T.H. Peeters and U. Nestle and F. McDonald and {Le Pechoux}, C. and R. Dziadziuszko and J. Belderbos and U. Ricardi and F. Manapov and Y. Lievens and X. Geets and K. Dieckmann and M. Guckenberger and N. Andratschke and K. Suveg and P.M. Putora",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/j.radonc.2020.10.043",

language = "English",

volume = "154",

pages = "269--273",

journal = "Radiotherapy and Oncology",

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publisher = "Elsevier Ireland Ltd",

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Glatzer, M, Faivre-Finn, C, De Ruysscher, D, Widder, J, Van Houtte, P, Troost, EGC, Slotman, B, Ramella, S, Pottgen, C, Peeters, STH, Nestle, U, McDonald, F, Le Pechoux, C, Dziadziuszko, R, Belderbos, J, Ricardi, U, Manapov, F, Lievens, Y, Geets, X, Dieckmann, K, Guckenberger, M, Andratschke, N, Suveg, K & Putora, PM 2021, 'Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine', Radiotherapy and Oncology, vol. 154, pp. 269-273. https://doi.org/10.1016/j.radonc.2020.10.043

TY - JOUR

T1 - Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine

AU - Glatzer, M.

AU - Faivre-Finn, C.

AU - De Ruysscher, D.

AU - Widder, J.

AU - Van Houtte, P.

AU - Troost, E.G.C.

AU - Slotman, B.

AU - Ramella, S.

AU - Pottgen, C.

AU - Peeters, S.T.H.

AU - Nestle, U.

AU - McDonald, F.

AU - Le Pechoux, C.

AU - Dziadziuszko, R.

AU - Belderbos, J.

AU - Ricardi, U.

AU - Manapov, F.

AU - Lievens, Y.

AU - Geets, X.

AU - Dieckmann, K.

AU - Guckenberger, M.

AU - Andratschke, N.

AU - Suveg, K.

AU - Putora, P.M.

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Background: Whole brain radiotherapy (WBRT) is a common treatment option for brain metastases secondary to non-small cell lung cancer (NSCLC). Data from the QUARTZ trial suggest that WBRT can be omitted in selected patients and treated with optimal supportive care alone. Nevertheless, WBRT is still widely used to treat brain metastases secondary to NSCLC. We analysed decision criteria influencing the selection for WBRT among European radiation oncology experts.Methods: Twenty-two European radiation oncology experts in lung cancer as selected by the European Society for Therapeutic Radiation Oncology (ESTRO) for previous projects and by the Advisory Committee on Radiation Oncology Practice (ACROP) for lung cancer were asked to describe their strategies in the management of brain metastases of NSCLC. Treatment strategies were subsequently converted into decision trees and analysed for agreement and discrepancies.Results: Eight decision criteria (suitability for SRS, performance status, symptoms, eligibility for targeted therapy, extra-cranial tumour control, age, prognostic scores and "Zugzwang" (the compulsion to treat)) were identified. WBRT was recommended by a majority of the European experts for symptomatic patients not suitable for radiosurgery or fractionated stereotactic radiotherapy. There was also a tendency to use WBRT in the ALK/EGFR/ROS1 negative NSCLC setting.Conclusion: Despite the results of the QUARTZ trial WBRT is still widely used among European radiation oncology experts. (C) 2020 Elsevier B.V. All rights reserved.

AB - Background: Whole brain radiotherapy (WBRT) is a common treatment option for brain metastases secondary to non-small cell lung cancer (NSCLC). Data from the QUARTZ trial suggest that WBRT can be omitted in selected patients and treated with optimal supportive care alone. Nevertheless, WBRT is still widely used to treat brain metastases secondary to NSCLC. We analysed decision criteria influencing the selection for WBRT among European radiation oncology experts.Methods: Twenty-two European radiation oncology experts in lung cancer as selected by the European Society for Therapeutic Radiation Oncology (ESTRO) for previous projects and by the Advisory Committee on Radiation Oncology Practice (ACROP) for lung cancer were asked to describe their strategies in the management of brain metastases of NSCLC. Treatment strategies were subsequently converted into decision trees and analysed for agreement and discrepancies.Results: Eight decision criteria (suitability for SRS, performance status, symptoms, eligibility for targeted therapy, extra-cranial tumour control, age, prognostic scores and "Zugzwang" (the compulsion to treat)) were identified. WBRT was recommended by a majority of the European experts for symptomatic patients not suitable for radiosurgery or fractionated stereotactic radiotherapy. There was also a tendency to use WBRT in the ALK/EGFR/ROS1 negative NSCLC setting.Conclusion: Despite the results of the QUARTZ trial WBRT is still widely used among European radiation oncology experts. (C) 2020 Elsevier B.V. All rights reserved.

KW - ALGORITHMS

KW - CELL LUNG-CANCER

KW - Decision tree

KW - Decision-making

KW - MULTICENTER

KW - NSCLC

KW - PHASE-3

KW - QUARTZ

KW - STEREOTACTIC RADIOSURGERY

KW - WBRT

U2 - 10.1016/j.radonc.2020.10.043

DO - 10.1016/j.radonc.2020.10.043

M3 - Article

C2 - 33186683

SN - 0167-8140

VL - 154

SP - 269

EP - 273

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -