Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts

P M Putora; G F Fischer; M Früh; R Califano; C Faivre-Finn; P Van Houtte; F McDonald; U Nestle; R Dziadziuszko; C Le Pechoux; S Ramella; J Belderbos; B J Slotman; E G C Troost; S Peeters; J Widder; C Pöttgen; M Reck; F Blackhall; F Cappuzzo; B Besse; S Novello; P Garrido; E Felip; M O'Brien; L Paz Ares; F de Marinis; V Westeel; D De Ruysscher

doi:10.1016/j.radonc.2020.04.015

Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts

Radiother Oncol. 2020 Aug:149:84-88. doi: 10.1016/j.radonc.2020.04.015. Epub 2020 Apr 20.

Authors

P M Putora¹, G F Fischer², M Früh³, R Califano⁴, C Faivre-Finn⁵, P Van Houtte⁶, F McDonald⁷, U Nestle⁸, R Dziadziuszko⁹, C Le Pechoux¹⁰, S Ramella¹¹, J Belderbos¹², B J Slotman¹³, E G C Troost¹⁴, S Peeters¹⁵, J Widder¹⁶, C Pöttgen¹⁷, M Reck¹⁸, F Blackhall⁵, F Cappuzzo¹⁹, B Besse²⁰, S Novello²¹, P Garrido²², E Felip²³, M O'Brien²⁴, L Paz Ares²⁵, F de Marinis²⁶, V Westeel²⁷, D De Ruysscher¹⁵

Affiliations

¹ Department of Radiation Oncology, Cantonal Hospital of St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Switzerland. Electronic address: 20bmsclc@data00.com.
² Department of Radiation Oncology, Cantonal Hospital of St. Gallen, Switzerland.
³ Department of Medical Oncology/Hematology, Cantonal Hospital of St. Gallen, Switzerland; University of Bern, Switzerland.
⁴ Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Department of Medical Oncology, Manchester University Hospital NHS Foundation Trust, UK; Division of Cancer Sciences, University of Manchester, UK.
⁵ Division of Cancer Sciences, University of Manchester & The Christie NHS Foundation Trust Manchester, UK.
⁶ Department of Radiation Oncology, Institut Jules Bordet Université Libre Bruxelles, Brussels, Belgium; Université Paris Sud, Le Kremlin Bicetre, France.
⁷ Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
⁸ Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, University Hospital Freiburg, Germany.
⁹ Department of Oncology and Radiotherapy, Medical University of Gdansk, Poland.
¹⁰ Department of Radiation Oncology, Gustave Roussy Cancer Campus, France.
¹¹ Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy.
¹² Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
¹³ Department of Radiation Oncology, Amsterdam University medical centers, location VUMC, Amsterdam, The Netherlands.
¹⁴ OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁵ Department of Radiation Oncology (Maastro), Maastricht University Medical Center, School for Oncology and Developmental Biology (GROW), The Netherlands.
¹⁶ Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
¹⁷ Department of Radiation Oncology, West German Tumor Centre, University of Duisburg-Essen Medical School, Germany.
¹⁸ LungenClinic Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany.
¹⁹ Director Oncology and Hematology Department, AUSL Romagna, Ravenna, Italy.
²⁰ Institut Gustave Roussy, Villejuif, France; Université Paris Sud, Le Kremlin Bicetre, France.
²¹ Oncology Department, AOU San Luigi, University of Turin, Italy.
²² Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
²³ Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain.
²⁴ Department of Medical Oncology, Royal Marsden Hospital, London.
²⁵ Hospital Universitario, Madrid, Spain.
²⁶ Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy.
²⁷ Chest Disease and Thoracic Oncology Department, University Hospital, University Bourgogne Franche-Comté INSERM UMR1098, Besançon, France.

PMID: 32445987
DOI: 10.1016/j.radonc.2020.04.015

Abstract

Background: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology.

Methods: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus.

Results and conclusion: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed. For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT. Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM.

Keywords: Brain metastases; Chemotherapy; Decision-making; Small cell lung cancer; Stereotactic radiotherapy; Whole brain radiotherapy.

MeSH terms

Brain Neoplasms* / radiotherapy
Cranial Irradiation
Humans
Lung Neoplasms*
Radiosurgery*
Small Cell Lung Carcinoma* / radiotherapy