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

Journal Paper/Review - Nov 11, 2020

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Citation
Glatzer M, Faivre-Finn C, De Ruysscher D, Widder J, Van Houtte P, Troost E, Slotman B, Ramella S, Pöttgen C, Peeters S, 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, Süveg K, Putora P. Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine. Radiother Oncol 2020; 154:269-273.
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Type
Journal Paper/Review (English)
Journal
Radiother Oncol 2020; 154
Publication Date
Nov 11, 2020
Issn Print
Issn Electronic
1879-0887
Pages
269-273
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Brief description/objective

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.