Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts

P. M. Putora; G. F. Fischer; M. Fruh; R. Califano; C. Faivre-Finn; P. Van Houtte; F. McDonald; U. Nestle; R. Dziadziuszko; C. Le Pechoux; S. Ramella; J. Belderbos; B. J. Slotman; E. G. C. Troost; S. Peeters; J. Widder; C. Pottgen; M. Reck; F. Blackhall; F. Cappuzzo; B. Besse; S. Novello; P. Garrido; E. Felip; M. O'Brien; L. Paz Ares; F. de Marinis; Virginie Westeel; D. De Ruysscher

doi:10.1016/j.radonc.2020.04.015

Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts

P. M. Putora^*, G. F. Fischer, M. Fruh, R. Califano, C. Faivre-Finn, P. Van Houtte, F. McDonald, U. Nestle, R. Dziadziuszko, C. Le Pechoux, S. Ramella, J. Belderbos, B. J. Slotman, E. G. C. Troost, S. Peeters, J. Widder, C. Pottgen, M. Reck, F. Blackhall, F. CappuzzoB. Besse, S. Novello, P. Garrido, E. Felip, M. O'Brien, L. Paz Ares, F. de Marinis, Virginie Westeel, D. De Ruysscher

^*Corresponding author for this work

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

Abstract

Background: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology.

Methods: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus.

Results and conclusion: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed.

For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT.

Original language	English
Pages (from-to)	84-88
Number of pages	5
Journal	Radiotherapy and Oncology
Volume	149
DOIs	https://doi.org/10.1016/j.radonc.2020.04.015
Publication status	Published - Aug 2020

Keywords

Decision-making
Small cell lung cancer
Brain metastases
Whole brain radiotherapy
Stereotactic radiotherapy
Chemotherapy
PROPHYLACTIC CRANIAL IRRADIATION
THORACIC RADIOTHERAPY
OPEN-LABEL
CHEMOTHERAPY
PHASE-3
MULTICENTER
VALIDATION
SELECTION
IASLC

Access to Document

10.1016/j.radonc.2020.04.015

Cite this

Putora, P. M., Fischer, G. F., Fruh, M., Califano, R., Faivre-Finn, C., Van Houtte, P., McDonald, F., Nestle, U., Dziadziuszko, R., Le Pechoux, C., Ramella, S., Belderbos, J., Slotman, B. J., Troost, E. G. C., Peeters, S., Widder, J., Pottgen, C., Reck, M., Blackhall, F., ... De Ruysscher, D. (2020). Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts. Radiotherapy and Oncology, 149, 84-88. https://doi.org/10.1016/j.radonc.2020.04.015

@article{3a049be0004545a5a0b7cb995303059e,

title = "Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts",

abstract = "Background: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology.Methods: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus.Results and conclusion: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed.For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT.Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM. (C) 2020 Published by Elsevier B.V.",

keywords = "Decision-making, Small cell lung cancer, Brain metastases, Whole brain radiotherapy, Stereotactic radiotherapy, Chemotherapy, PROPHYLACTIC CRANIAL IRRADIATION, THORACIC RADIOTHERAPY, OPEN-LABEL, CHEMOTHERAPY, PHASE-3, MULTICENTER, VALIDATION, SELECTION, IASLC",

author = "Putora, {P. M.} and Fischer, {G. F.} and M. Fruh and R. Califano and C. Faivre-Finn and {Van Houtte}, P. and F. McDonald and U. Nestle and R. Dziadziuszko and {Le Pechoux}, C. and S. Ramella and J. Belderbos and Slotman, {B. J.} and Troost, {E. G. C.} and S. Peeters and J. Widder and C. Pottgen and M. Reck and F. Blackhall and F. Cappuzzo and B. Besse and S. Novello and P. Garrido and E. Felip and M. O'Brien and {Paz Ares}, L. and {de Marinis}, F. and Virginie Westeel and {De Ruysscher}, D.",

note = "Funding Information: PMP reports speaker fees from Janssen and institutional educational grants from AstraZeneca and Celgene. VW reports personal fees from Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myers-Squibb, Lilly, MSD, Pfizer, Roche, Takeda. Publisher Copyright: {\textcopyright} 2020",

year = "2020",

month = aug,

doi = "10.1016/j.radonc.2020.04.015",

language = "English",

volume = "149",

pages = "84--88",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

Putora, PM, Fischer, GF, Fruh, M, Califano, R, Faivre-Finn, C, Van Houtte, P, McDonald, F, Nestle, U, Dziadziuszko, R, Le Pechoux, C, Ramella, S, Belderbos, J, Slotman, BJ, Troost, EGC, Peeters, S, Widder, J, Pottgen, C, Reck, M, Blackhall, F, Cappuzzo, F, Besse, B, Novello, S, Garrido, P, Felip, E, O'Brien, M, Paz Ares, L, de Marinis, F, Westeel, V & De Ruysscher, D 2020, 'Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts', Radiotherapy and Oncology, vol. 149, pp. 84-88. https://doi.org/10.1016/j.radonc.2020.04.015

TY - JOUR

T1 - Treatment of brain metastases in small cell lung cancer

T2 - Decision-making amongst a multidisciplinary panel of European experts

AU - Putora, P. M.

AU - Fischer, G. F.

AU - Fruh, M.

AU - Califano, R.

AU - Faivre-Finn, C.

AU - Van Houtte, P.

AU - McDonald, F.

AU - Nestle, U.

AU - Dziadziuszko, R.

AU - Le Pechoux, C.

AU - Ramella, S.

AU - Belderbos, J.

AU - Slotman, B. J.

AU - Troost, E. G. C.

AU - Peeters, S.

AU - Widder, J.

AU - Pottgen, C.

AU - Reck, M.

AU - Blackhall, F.

AU - Cappuzzo, F.

AU - Besse, B.

AU - Novello, S.

AU - Garrido, P.

AU - Felip, E.

AU - O'Brien, M.

AU - Paz Ares, L.

AU - de Marinis, F.

AU - Westeel, Virginie

AU - De Ruysscher, D.

N1 - Funding Information: PMP reports speaker fees from Janssen and institutional educational grants from AstraZeneca and Celgene. VW reports personal fees from Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myers-Squibb, Lilly, MSD, Pfizer, Roche, Takeda. Publisher Copyright: © 2020

PY - 2020/8

Y1 - 2020/8

N2 - Background: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology.Methods: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus.Results and conclusion: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed.For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT.Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM. (C) 2020 Published by Elsevier B.V.

AB - Background: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology.Methods: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus.Results and conclusion: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed.For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT.Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM. (C) 2020 Published by Elsevier B.V.

KW - Decision-making

KW - Small cell lung cancer

KW - Brain metastases

KW - Whole brain radiotherapy

KW - Stereotactic radiotherapy

KW - Chemotherapy

KW - PROPHYLACTIC CRANIAL IRRADIATION

KW - THORACIC RADIOTHERAPY

KW - OPEN-LABEL

KW - CHEMOTHERAPY

KW - PHASE-3

KW - MULTICENTER

KW - VALIDATION

KW - SELECTION

KW - IASLC

U2 - 10.1016/j.radonc.2020.04.015

DO - 10.1016/j.radonc.2020.04.015

M3 - Article

C2 - 32445987

SN - 0167-8140

VL - 149

SP - 84

EP - 88

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -