Interim Data from the Medical Research Council QUARTZ Trial: Does Whole Brain Radiotherapy Affect the Survival and Quality of Life of Patients with Brain Metastases from Non-small Cell Lung Cancer?

Langley, Ruth E.; Stephens, Richard; Nankivell, Matthew; Pugh, Cheryl; Moore, Barbara; Navani, Neal; Wilson, Paula; Faivre-Finn, Corinne; Barton, Rachael; Parmar, Mahesh; Mulvenna, P.

doi:10.1016/j.clon.2012.11.002

Cited by 89 publications

(55 citation statements)

References 20 publications

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“…53 A recent phase III non-inferiority trial in patients with brain metastases from NSCLC, not a candidate for either surgery or radiosurgery, has not shown differences in OS and quality of life between WBRT and supportive care (class I). 54 To date, radiosensitizers have not provided any clear additional benefit over conventional radiotherapy.…”

Section: Whole-brain Radiotherapymentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

409

338

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The management of patients with brain metastases has become a major issue due to the increasing frequency and complexity of the diagnostic and therapeutic approaches. In 2014, the European Association of NeuroOncology (EANO) created a multidisciplinary Task Force to draw evidence-based guidelines for patients with brain metastases from solid tumors. Here, we present these guidelines, which provide a consensus review of evidence and recommendations for diagnosis by neuroimaging and neuropathology, staging, prognostic factors, and different treatment options. Specifically, we addressed options such as surgery, stereotactic radiosurgery/stereotactic fractionated radiotherapy, whole-brain radiotherapy, chemotherapy and targeted therapy (with particular attention to brain metastases from non-small cell lung cancer, melanoma and breast and renal cancer), and supportive care. Key wordsbrain metastases | chemotherapy | neuroimaging | neuropathology | stereotactic radiosurgery/stereotactic fractionated radiotherapy | supportive care | surgery | targeted therapy | whole-brain radiation therapy

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Section: Whole-brain Radiotherapymentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

409

338

View full text Add to dashboard Cite

show abstract

“…A recent audit of clinical practice in Nordland Hospital (Bodø, Nordland, Norway) between 2007 and 2009 revealed that 9% of all palliative radiotherapy was administered to patients during their last month of life (10). In other words, the physician's decision-making was appropriate in ~9 out of 10 patients, based on the assumption that patients with extremely short survival time are unlikely to experience any significant improvement in symptoms or quality of life (11). Due to the lack of patient-reported outcomes, the clinical benefit of palliative radiotherapy during the last month of life was not analyzed in the present study.…”

Section: Introductionmentioning

confidence: 99%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

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Abstract.Oncologists commonly overestimate the survival time of patients receiving palliative therapy, which may result in the administration of treatments that are too aggressive for patients near the end of their lives. Previous studies have discussed the negative implications of palliative radiotherapy if administered during the last month of life. Models predicting a limited survival time may improve the ability of the oncologists to tailor the treatment according to the needs of each individual patient. In the present study, prognostic factors for survival time, and the use of palliative radiotherapy during the last month of life, were analyzed in 873 patients. Models predicting the likelihood of administering such therapy were examined, and the risk of receiving radiotherapy during the last month of life was observed to be lower in patients with non-metastatic cancer than in those with metastatic cancer (7 vs. 13%, respectively; P=0.12). On multivariate analysis, 11 factors that significantly influenced the survival time were identified. These findings emphasize the complexity of potential prediction models. The most important risk factor regarding the prediction of extremely short survival times was observed to be an Eastern Cooperative Oncology Group performance status (ECOG PS) of 4, followed by an ECOG PS of 3 (median survival times, 14 and 64 days, respectively). A limited number of patients who received palliative radiotherapy during their last month of life died unexpectedly. Disease-specific prediction models were developed; however, the small number of events available for analysis limited their immediate clinical impact. Furthermore, these prediction models identified a minority of patients who received radiotherapy during the last month of life. In conclusion, the majority of the palliative radiotherapy courses administered to patients with advanced cancer during their last month of life may be preventable if accurate decision models for the clinic are developed. However, due to the complexity associated with the prediction of survival times in patients receiving palliative radiotherapy, large databases are required to allow accurate models to be established. The present study also discusses the recommendations of the Department of Oncology and Palliative Medicine of Nordland Hospital (Bodø, Nordland, Norway) with regard to the use of palliative radiotherapy during the last month of life of patients with terminal cancer.

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“…However, data on the purported benefit of WBrT are highly controversial. The QUarTZ study found no significant benefit of adding WBrT in non-small cell lung cancer (Nsclc) patients 8 and Nieder et al also confirmed that there was no significant benefit of WBrT with one exception and that was a group of patients with small cell lung cancer. This small sub-group benefited from a WBrT of 30 Gy (ref.…”

Section: Discussionmentioning

confidence: 75%

Radiotherapy management of brain metastases using conventional linear accelerator

Matzenauer¹,

Vrána²,

Vlachová³

et al. 2016

BIOMED PAP

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Background and Aims. As treatments for primary cancers continue to improve life expectancy, unfortunately, brain metastases also appear to be constantly increasing and life expectancy for patients with brain metastases is low. Longer survival and improved quality of life may be achieved using localised radiological and surgical approaches in addition to low dose corticosteroids. Stereotactic brain radiotherapy is one rapidly evolving localized radiation treatment. This article describes our experience with stereotactic radiotherapy using a linear accelerator. Methods. We reviewed patients treated with stereotactic radiotherapy, from the time of its introduction into daily practice in our Department of Oncology in 2014. We collected the data on patient treatment and predicted survival based on prognostic indices and actual patient outcome. Results. A total of 10 patients were treated by stereotactic radiotherapy, in one case in combination with whole brain radiotherapy and hippocampal sparing. There was no significant treatment related toxicity during the treatment or follow-up and due to the small number of fractions, the overall tolerance of the treatment was excellent. The patient intrafractional movement in all cases was under 1 mm suggesting that 1 mm margin around the CTV to create the PTV is sufficient and also that patient immobilization using the thermoplastic mask compared with invasive techniques, is feasible. We also found that prognostic indices such as the Graded Prognostic Assessment provide accurate predictions of patient survival. Conclusions. Based on our current evidence, patients with brain metastases fit enough, should be considered for stereotactic radiotherapy treatment.

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Interim Data from the Medical Research Council QUARTZ Trial: Does Whole Brain Radiotherapy Affect the Survival and Quality of Life of Patients with Brain Metastases from Non-small Cell Lung Cancer?

Cited by 89 publications

References 20 publications

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

Radiotherapy management of brain metastases using conventional linear accelerator

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