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Radiotherapy versus best supportive care in patients with brain metastases and adverse prognostic factors

Clinical & Experimental Metastasis volume 30, pages 723–729 (2013)Cite this article

Abstract

Several previous studies have suggested that patients with brain metastases should be treated with individualized approaches taking into account prognostic factors that influence survival. Whether or not radiotherapy represents overtreatment in patients with adverse prognostic features is currently being addressed in the randomized QUARTZ trial (best supportive care (BSC) vs. whole brain radiotherapy (WBRT)). However, inclusion is limited to patients with primary non-small cell lung cancer. Therefore, we analyzed a broader patient population with different primary tumors managed with BSC or WBRT (intended total dose 20 or 30 Gy). Survival was examined by uni- and multivariate analyses including matched pairs. Median overall survival of all 113 patients was 2 months. No significant difference between BSC and 20 Gy WBRT was observed. A slight but significant improvement was observed in the 30 Gy WBRT group (median 2.2 vs. 1.7 months). The magnitude of difference is not clinically meaningful. Subgroup analyses revealed that improved survival after 30 Gy WBRT was limited to patients with primary small cell lung cancer. In conclusion, these results confirm and extent interim results from the QUARTZ trial, suggesting that BSC is a reasonable choice in patients with limited survival expectation. Further efforts are necessary to improve identification of patients who are likely to benefit from WBRT, e.g. by refining available survival prediction tools, and to confirm that management of those with small cell lung cancer should include a less restricted use of WBRT.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway

    Carsten Nieder, Astrid Dalhaug, Gro Aandahl & Adam Pawinski

  2. Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway

    Carsten Nieder, Jan Norum & Astrid Dalhaug

  3. Department of Oncology, University Hospital of Northern Norway, 9038, Tromsø, Norway

    Jan Norum

  4. Northern Norway Regional Health Authority Trust, Bodø, Norway

    Jan Norum

Authors
  1. Carsten Nieder
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  2. Jan Norum
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  3. Astrid Dalhaug
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  4. Gro Aandahl
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  5. Adam Pawinski
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Correspondence to Carsten Nieder.

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Nieder, C., Norum, J., Dalhaug, A. et al. Radiotherapy versus best supportive care in patients with brain metastases and adverse prognostic factors. Clin Exp Metastasis 30, 723–729 (2013). https://doi.org/10.1007/s10585-013-9573-x

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  • DOI: https://doi.org/10.1007/s10585-013-9573-x

Keywords

  • Brain metastases
  • Prognostic factors
  • Radiotherapy
  • Best supportive care