Applying the QUARTZ Trial Results in Clinical Practice: Development of a Prognostic Model Predicting Poor Outcomes for Non-small Cell Lung Cancers with Brain Metastases

Agarwal, Jai Prakash; Chakraborty, Santam; Laskar, Siddhartha; Mummudi, Naveen; Patil, Vijay; Upasani, M.; Prabhash, Kumar; Noronha, Vanita; Joshi, Amit; Purandare, Nilendu; Tandon, Sandeep; Arora, Jitendra; Badhe, Rupali

doi:10.1016/j.clon.2018.02.002

Cited by 15 publications

(16 citation statements)

References 33 publications

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“…Especially for controlled extracranial most of our experts recommended WBRT in patients unsuitable for SRS, as patients with favourable prognosis benefit from WBRT. This is in-line with published literature:Agarwal et al (14) investigated prognostic factors to identify patients with poor prognosis who may not benefit from WBRT and translated the factors into a prognostic model. They mentioned EGFR mutation, KPS and gender as significant prognostic factors of overall survival.…”

Section: Discussionsupporting

confidence: 85%

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

Glatzer

Faivre-Finn

Ruysscher

et al. 2021

Radiotherapy and Oncology

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Section: Discussionsupporting

confidence: 85%

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

Glatzer

Faivre-Finn

Ruysscher

et al. 2021

Radiotherapy and Oncology

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“…Selected patients may also be considered for best supportive care (BSC) including corticosteroids. In a randomized trial of patients with brain metastases from non-small cell lung cancer and a very poor survival prognosis, treatment with BSC and dexamethasone was not inferior to BSC and dexamethasone plus short-course WBRT with 20 Gy in 5 fractions [21,22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Diagnosis-Specific Survival Scores for Patients with Small-Cell Lung Cancer Irradiated for Brain Metastases

Rades

Hansen

Schild

2019

Cancers

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Diagnosis-specific survival scores including a new score developed in 157 patients with brain metastases from small-cell lung cancer (SCLC) receiving whole-brain radiotherapy (WBRT) with 30 Gy in 10 fractions (WBRT-30-SCLC) were compared. Three prognostic groups were designed based on the 6-month survival probabilities of significant or almost significant factors, (age, performance score, number of brain metastases, extra-cerebral metastasis). Six-month survival rates were 6% (6–11 points), 44% (12–14 points) and 86% (16–19 points). The WBRT-30-SCLC was compared to three disease-specific scores for brain metastasis from SCLC, the original and updated diagnosis-specific graded prognostic assessment DS-GPA classifications and the Rades-SCLC. Positive predictive values (PPVs) used to correctly predict death ≤6 months were 94% (WBRT-30-SCLC), 88% (original DS-GPA), 88% (updated DS-GPA) and 100% (Rades-SCLC). PPVs to predict survival ≥6 months were 86%, 75%, 76% and 100%. For WBRT-30-SCLC and Rades-SCLC, differences between poor and intermediate prognoses groups and between intermediate and favorable prognoses groups were significant. For both DS-GPA classifications, only the difference between poor and intermediate prognoses groups was significant. Of these disease-specific tools, Rades-SCLC appeared to be the most accurate in identifying patients dying ≤6 months and patients surviving ≥6 months after irradiation, followed by the new WBRT-30-SCLC and the DS-GPA classifications.

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“…An over-optimistic estimation of patients’ prognosis may partially explain the utilization of radiotherapy near the end of life. Recent studies have tried to quantify utilization rates [16, 26] and have also suggested prognostic models, which may lead to improved decision-making by radiation oncologists [11, 14, 17, 27–29]. However, the perfect prognostic model has yet to be developed.…”

Section: Discussionmentioning

confidence: 99%

Management of patients with brain metastases from non-small cell lung cancer and adverse prognostic features: multi-national radiation treatment recommendations are heterogeneous

et al. 2019

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Background Different management options exist for patients with brain metastases from non-small cell lung cancer (NSCLC), patients whose treatment with whole brain radiotherapy (WBRT) has become more controversial over the last decade. It is not trivial to find the optimal balance of over- versus undertreatment in these patients. Several recent trials, including the randomized QUARTZ trial now influence the decision to recommend or withhold WBRT for patients with unfavorable prognosis, and similarly, for favorable prognosis patients, the balance between radiosurgery alone or WBRT has become a nuanced decision. Additionally, the availability of intracranially active targeted agent for some subsets of these patients has added another layer of complexity to the decision-making. Methods A multinational consortium of expert radiation oncologists was established with the aim of compiling treatment recommendations for challenging scenarios, in this case the choice between optimal supportive care (SC), WBRT and other types of radiation therapy (RT). We distributed 17 cases to 7 radiation oncologists who were allowed to involve coworkers to provide their treatment recommendations. The cases differed in extra- and intracranial disease extent, histology, age and other prognostic factors. Expert recommendations were tabulated with the aim of providing guidance. Results Regarding willingness to include the 17 patients in the QUARTZ trial, the rates of trial inclusion were low (range 0/7 to 3/7). Experts not recommending trial inclusion provided their treatment recommendations. These suggestions differed widely for most of the patients. It was not uncommon to see 3 or 4 different recommendations. In general, few (0–2) recommended SC. Some kind of local treatment was suggested by the majority of experts for all 17 patients. Commonly, stereotactic single-fraction radiosurgery (SRS) or stereotactic fractionated radiotherapy (SFRT) were recommended by many experts, also for patients with 5–7 lesions. The highest proportion of recommendations towards WBRT in any patient was 3/7. It was also quite common for patients with multiple metastases of varying size that experts suggested combinations of resection, post-operative SRS/SFRT and SRS/SFRT to intact lesions. Despite recommending active treatment, experts were often willing to include the patients in a hypothetical protocol investigating radiotherapy utilization in the last 30 days of life (assessment of factors predicting early death). Conclusions WBRT was infrequently recommended. Even in patients with adverse prognostic features that raised the experts’ awareness of an increased risk for futile treatment near the end of life, SRS/SFRT were more often recommended than optimal supportive care, unless a patient decided to forego active treatment. Electronic supplementary material The online version of this article (10.1186/s13014-019-1237-9) contains...

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Applying the QUARTZ Trial Results in Clinical Practice: Development of a Prognostic Model Predicting Poor Outcomes for Non-small Cell Lung Cancers with Brain Metastases

Cited by 15 publications

References 33 publications

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

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

Comparison of Diagnosis-Specific Survival Scores for Patients with Small-Cell Lung Cancer Irradiated for Brain Metastases

Management of patients with brain metastases from non-small cell lung cancer and adverse prognostic features: multi-national radiation treatment recommendations are heterogeneous

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