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Radiation Oncology • Neuro-Oncology
Would you withhold whole brain radiation therapy for pts with brain metastases from NSCLC unsuitable for resection or stereotactic radiotherapy?
What is your interpretation of the recently published QUARTZ trial? Is there a population of patients that you would consider withholding radiation therapy?
Answer from: Radiation Oncologist at Academic Institution
The QUARTZ trial, published earlier this month, was a phase III non-inferiority trial with a primary endpoint of quality-adjusted life-days and pragmatic inclusion criteria. Patients with NSCLC who were unable to undergo SRS or resection were randomized to supportive care (OSC) with or without WBRT ...
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Answer from: Radiation Oncologist at Community Practice
Clinicians now have level 1 evidence that will help inform discussions with patients with non-small cell lung cancer and brain metastases not suitable for surgery or stereotactic radiosurgery. The QUARTZ trial results confirm that whole brain radiotherapy can be safely omitted for patients with NSCL...
Answer from: Radiation Oncologist at Community Practice
We all need to remember to use our brain when thinking about treating one. We also need to read QUARTZ very carefully and memorize the study population before thinking about extrapolating it to our patients in the clinic. Sure, a patient who has >20% unexplained weight loss, ECOG 2-3 over the pas...
Answer from: Radiation Oncologist at Community Practice
I think there is a lot of useful information that is either not collected or not reported here. As dr Turrisi mentioned, extracranial disease is important as a competitive confounder.
Essentially, the good performance status and good performers with controlled disease, etc are all excluded h...
Answer from: Radiation Oncologist at Community Practice
I would be cautious in interpretation of the Quartz trial. Working in a center that recruited patients to this trial, in my experience the lung radiation oncologists would give WBRT to the fitter patients and those with lower disease burden rather than enter them into this trial. Although they claim...
Answer from: Radiation Oncologist at Community Practice
The current trend selects patients for SRS, treating those selected, and then thinking that "toxicity" of WBRT may warrant skipping it. The RPA, leaning heavily on peripheral disease status, PS, and then the issue of symptoms all weigh in. The study QUARTZ was done in the UK and Australia for NSCLC ...
Answer from: Radiation Oncologist at Community Practice
We presented a small series at the American Radium society meeting about 10 years ago. In our small series no patient who was over the age of 60, and had to be in the hospital the entire time they recieved whole brain radiation, lived more than two months. Clearly there is a group of patients where ...