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

Nieder, Carsten; Guckenberger, Matthias; Gaspar, Laurie E.; Rusthoven, Chad G.; De Ruysscher, Dirk; Sahgal, Arjun; Nguyen, Timothy; Grosu, Anca L.; Mehta, Minesh P.

doi:10.1186/s13014-019-1237-9

Table 2 Patient characteristics and treatment recommendations if the QUARTZ trial would not have been recommended

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

Patient nr.	Age in years	NSCLC type	DS-GPA	Predicted risk of early death^a	Predicted probability of survival > 12 mo	Actual survival	Treatment recommended	Evidence for advantage from WBRT (level 1b) from the QUARTZ trial based on Forest plot of overall survival
1	69	squamous cell	0.5	97	0	0.4^b	SFRT: 4 (SC: 1)	No^m
2	60	poorly diff.	1.0	68	10	0.3^b	SRS: 4 (SC: 1)	No
3	58	adeno NSCLC	1.0	Not eligible	Not eligible	1.4^b	SFRT: 3 (SC: 1)^c	Yes (reason: age < 60)
4	69	poorly diff.	1.0	73	6	1.6^b	SFRT: 4 (SC: 1)	No
5	61	poorly diff.	0.0	82	3	1.0^b	SFRT: 4 (SC: 1)^d	No
6	64	squamous cell	1.5	65	9	2.0^b	SRS: 5 (SC: 1)	No
7	85	squamous cell	1.0	81	3	0.6^b	SRS: 6	No
8	66	adeno NSCLC	0.0	41	20	1.8^b	SRS: 3 (SC: 1)^e	No
9	65	poorly diff.	0.5	89	3	2.3^b	SRS: 2 (SC: 1)^f	No
10	77	adeno NSCLC	1.0	83	4	0.7^b	SRS: 3 (SC: 1)^g	No
11	62	adeno NSCLC	0.5	44	18	5.3	SRS: 4 (SC: 1)^h	No
12	78	adeno EGFR mut.	0.0	95	0	2.6	SFRT: 2 (SC: 2)ⁱ	No
13	64	adeno NSCLC	0.0	71	8	0.6	SRS: 3 (SC: 1)	No
14	68	adeno NSCLC	0.5	73	6	1.9	SFRT: 3 (SC: 1)^j	No
15	66	squamous cell	0.5	66	9	1.2	WBRT: 2 (SC: 2)	No
16	65	adeno NSCLC	0.5	84	3	0.5	SFRT: 4 (SC: 1)^k	No
17	53	adeno NSCLC	1.0	79	4	1.3	Resection: 2 (SC: 2)^l	Yes (reason: age < 60)

^anomogram predicts early death (< 3 months) and survival > 12 months after SRS (Zindler et al. [15])
^boptimal supportive care (nr. 11–17: whole-brain radiotherapy with 5 fractions of 4 Gy; survival in months)
^ctwo would have combined SFRT and SRS, another two had a strong preference for resection of the largest lesion
^dthree would have combined SFRT and SRS
^eone would have combined SRS and WBRT, two would have given WBRT alone
^ftwo had a strong preference for resection of the largest lesion
^gtwo would have given WBRT alone
^hone would have combined SRS and WBRT, one would have combined SFRT and SRS, two would have given WBRT alone
ⁱtwo had a strong preference for resection of the largest lesion, two would have included WBRT as component of care, one would have combined SFRT and SRS
^jtwo had a strong preference for resection of the largest lesion, one would have combined SFRT and SRS
^kone had a strong preference for resection of the cerebellar lesion, one would have combined SFRT and SRS, one would have combined SFRT and WBRT
^lresection would have followed by SFRT/SRS to other lesions/cavity, one would have combined SFRT and SRS, one would have given WBRT alone
^mthe Forest plot showed improved survival 1) for patients aged younger than 60 years and 2) those with GPA 2.5–3.0
NSCLC: non-small cell lung cancer; EGFR: epidermal growth factor receptor; DS-GPA: disease-specific graded prognostic assessment; WBRT: whole-brain radiotherapy; SFRT: stereotactic fractionated radiotherapy; SRS: stereotactic single-fraction radiosurgery

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ISSN: 1748-717X

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