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.

• Authors: Markus Glatzer, Corinne Faivre-Finn, Dirk De Ruysscher, Joachim Widder, Paul Van Houtte, Esther G C Troost, Ben J Slotman, Sara Ramella, Christoph Pöttgen, Stephanie T H Peeters, Ursula Nestle, Fiona McDonald, Cecile Le Pechoux, Rafal Dziadziuszko, José Belderbos, Umberto Ricardi, Farkhad Manapov, Yolande Lievens, Xavier Geets, Karin Dieckmann, Matthias Guckenberger, Nicolaus Andratschke, Krisztian Süveg, Paul M Putora
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 154 Pg. 269-273 (01 2021) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 33186683 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Chemical References

• Proto-Oncogene Proteins
• Protein-Tyrosine Kinases

Topics

• Brain Neoplasms (radiotherapy)
• Carcinoma, Non-Small-Cell Lung (radiotherapy)
• Cranial Irradiation
• Humans
• Lung Neoplasms (radiotherapy)
• Protein-Tyrosine Kinases
• Proto-Oncogene Proteins
• Radiation Oncology
• Radiosurgery