Markus Glatzer1, Corinne Faivre-Finn2, Dirk De Ruysscher3, Joachim Widder4, Paul Van Houtte5, Esther G C Troost6, Ben J Slotman7, Sara Ramella8, Christoph Pöttgen9, Stephanie T H Peeters3, Ursula Nestle10, Fiona McDonald11, Cecile Le Pechoux12, Rafal Dziadziuszko13, José Belderbos14, Umberto Ricardi15, Farkhad Manapov16, Yolande Lievens17, Xavier Geets18, Karin Dieckmann4, Matthias Guckenberger19, Nicolaus Andratschke19, Krisztian Süveg20, Paul M Putora21. 1. Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland. Electronic address: Markus.glatzer@kssg.ch. 2. Division of Cancer Sciences, University of Manchester & The Christie NHS Foundation Trust Manchester, United Kingdom. 3. Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands. 4. Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria. 5. Department of Radiation Oncology, Institut Bordet, Université Libre Bruxelles, Belgium. 6. Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany. 7. Department of Radiation Oncology, Amsterdam University Medical Centers, VUMC, The Netherlands. 8. Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy. 9. Department of Radiation Oncology, West German Tumor Centre, University of Duisburg-Essen Medical School, Germany. 10. Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, University Hospital Freiburg, Germany. 11. Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom. 12. Departement Oncologie Radiotherapie, Gustave Roussy, Villejuif, France. 13. Department of Oncology and Radiotherapy, Gdansk, Poland. 14. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 15. Department of Oncology, University of Turin, Italy. 16. Department of Radiation Oncology, LMU Klinikum, University of Munich, Germany. 17. Radiation Oncology Department, Ghent University Hospital and Ghent University, Belgium. 18. Department of Radiation Oncology, Cliniques universitaires Saint-Luc, MIRO - IREC Lab, UCL, Belgium. 19. Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland. 20. Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland. 21. Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Switzerland.
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.
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; Kari Tanderup; Angeles Rovirosa; Lars Fokdal; Claudia Ordeanu; Luca Tagliaferri; Cyrus Chargari; Vratislav Strnad; Johannes Athanasios Dimopoulos; Barbara Šegedin; Rachel Cooper; Esten Søndrol Nakken; Primoz Petric; Elzbieta van der Steen-Banasik; Kristina Lössl; Ina M Jürgenliemk-Schulz; Peter Niehoff; Ruth S Hermansson; Remi A Nout; Paul Martin Putora; Ludwig Plasswilm; Nikolaos Tselis Journal: Cancers (Basel) Date: 2022-02-11 Impact factor: 6.639
Authors: Margarita Martin; Raúl Hernanz; Carmen Vallejo; Leonardo Guerrero; Xabier Mielgo; Ana Lopez; Juan Carlos Trujillo-Reyes; Felipe Couñago Journal: Rep Pract Oncol Radiother Date: 2022-07-29