Skip to main content

Main menu

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
    • Special Issues 2025
  • Journal Metrics
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
Anticancer Research
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics
  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Anticancer Research

Advanced Search

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
    • Special Issues 2025
  • Journal Metrics
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Visit us on Facebook
  • Follow us on Linkedin
Research ArticleClinical Studies

Confirmatory Analysis of QUARTZ Study Results: Survival Prolongation After Whole-brain Radiotherapy

CARSTEN NIEDER, ASTRID DALHAUG and ADAM PAWINSKI
Anticancer Research February 2020, 40 (2) 977-981; DOI: https://doi.org/10.21873/anticanres.14031
CARSTEN NIEDER
1Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
2Department of Clinical Medicine, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: carsten.nieder@nlsh.no
ASTRID DALHAUG
1Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
ADAM PAWINSKI
1Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background/Aim: The aim of this study was to analyze the survival of patients with brain metastases treated with best supportive care or additional whole-brain radiotherapy (WBRT), in order to confirm results from the prospective randomized QUARTZ study, which suggested prolonged survival after WBRT (5 fractions of 4 Gy) if favorable prognostic factors were present (age younger than 60 years, graded prognostic assessment score 2.5-3 points). Patients and Methods: We performed a retrospective single institution analysis of 76 patients with favorable prognosis. In contrast to the QUARTZ trial, inclusion was not limited to patients with non-small cell lung cancer (NSCLC). Furthermore, a cohort treated with higher total doses of WBRT was included (10 fractions of 3 Gy). Results: All patients were younger than 60 years or had a graded prognostic assessment score of 2.5-3. The median survival was significantly shorter after best supportive care (1.2 months; 3.2 months after WBRT with 5 fractions of 4 Gy and 3.9 months after 10 fractions of 3 Gy). Also, in multivariate analyses, survival was significantly better after WBRT. Further favorable prognostic factors included better performance status, no or limited extracranial metastases and primary tumor other than gastrointestinal. Conclusion: In line with the QUARTZ trial results, WBRT prolonged survival in patients with favorable prognostic features.

  • Palliative radiotherapy
  • whole-brain radiotherapy
  • supportive care
  • brain metastases
  • prognostic factors

In patients with brain metastases from extracranial primary tumors, such as lung or breast cancer, current treatment options include surgical resection and stereotactic radiotherapy, as well as whole-brain radiotherapy (WBRT) and best supportive care (BSC) without metastases-directed approaches (1-3). Patient selection is not always trivial, especially when it comes to the decision to withhold active, metastases-directed approaches (4-6). The prospective randomized multicenter QUARTZ trial was a pragmatic trial performed between 2007 and 2014 (7). The protocol required uncertainty in the clinicians' or patients' minds about the potential benefit of WBRT and used a non-inferiority design. All patients had non-small cell lung cancer (NSCLC) and were offered BSC including dexamethasone, which a significant majority received. In the WBRT arm, treatment consisted of 5 fractions of 4 Gy each. The primary outcome measure was quality-adjusted life-years (QALYs). Median age was 66 years (range=38-85 years). The authors concluded that there was no significant difference in QALYs between the two treatment arms (mean=46.4 QALY days for the WBRT arm versus 41.7 QALY days for WBRT and BSC, respectively). There was also no significant difference observed in overall survival (hazard ratio=1.06, 95% confidence interval=0.90-1.26) between the two groups. In the WBRT arm, median survival was 9.2 weeks. However, WBRT prolonged survival in patients younger than 60 years of age (hazard ratio=1.48, 95% confidence interval=1.01-2.16) and those with graded prognostic assessment (GPA) score of 2.5-3 points (hazard ratio=1.65, 95% confidence interval=1.04-2.60). The GPA score is a widely used 4-tiered prognostic model based on different baseline parameters, which differ by primary diagnosis, e.g. lung cancer, breast cancer, malignant melanoma and kidney cancer (8). Given that many patients with brain metastases have primary tumors other than NSCLC, we designed a retrospective study of WBRT versus BSC that included all patients irrespective of primary tumor, if they had the same favorable prognostic features that were associated with better survival after WBRT in the QUARTZ trial, i.e. age younger than 60 years or diagnosis-specific GPA 2.5-3 points. Furthermore, we included an additional group of patients treated with WBRT who received a higher total dose than in the QUARTZ trial (10 fractions of 3 Gy).

Patients and Methods

Patients and treatment. A retrospective study of all patients with parenchymal brain metastases from histologically verified extracranial primary tumors treated with WBRT (5 fractions of 4 Gy or 10 fractions of 3 Gy, no boost) or BSC at our hospital was performed. The patients were treated between January 01, 2007 and December 31, 2018 and identified from a continuously updated database (9, 10). None of the patients had received previous treatment for brain metastases (neither prophylactic cranial irradiation). After WBRT, further systemic and local treatment was individualized. The choice between the two WBRT regimens was at the discretion of the radiation oncologist. BSC was typically pursued if recommended by the multidisciplinary tumor board and agreed by the patients and caregivers. Factors such as old age, poor Karnofsky performance score (KPS) and extensive metastatic spread were common reasons to recommend BSC. The diagnosis-specific GPA was assigned as originally described by Sperduto et al. (8). The maximum point sum was 4, and the minimum 0. A point sum of 2.5-3 indicates a relatively good prognosis. Inclusion was limited to patients with 2.5-3 points or age younger than 60 years.

Statistical methods. Overall survival (time to death) from imaging diagnosis of brain metastases was calculated employing the Kaplan-Meier method, and different groups were compared using the log-rank test (SPSS 25, IBM Corp., Armonk, NY, USA). Only two patients were censored. Date of death was known in all other patients. A Cox forward conditional regression model was employed for multivariate analysis. The chi-square test was used to compare differences in baseline characteristics between the patient groups. Statistical significance was defined as p≤0.05 throughout this study.

Results

Patient characteristics. We identified 76 patients from the database. Thirty-two (42%) had NSCLC. The median age was 55.5 years. Twenty patients (26%) were included because of their favorable diagnosis-specific GPA score, meaning that age younger than 60 years was the prevailing reason for inclusion. Further patient characteristics are shown in Table I.

Treatment. Fourteen patients (18%) received BSC, 9 (12%) WBRT with the 5-fraction regimen and 53 (70%) with the 10-fraction regimen. In the latter group, one patient did not complete all 10 fractions of WBRT.

Survival. The median overall survival of the BSC group was 1.2 months. As shown in Figure 1, WBRT was associated with significantly better survival. The difference between the 5- and 10-fraction regimens was not statistically significant. Beyond WBRT, other factors were associated with better survival: female gender (p=0.057), non-gastrointestinal primary tumor (p=0.025), no extracranial metastases or to one organ only (p=0.009), better KPS (p=0.0001), 1-3 brain metastases (p=0.027), better diagnosis-specific GPA (p=0.001).

Importantly, patients in the 10-fraction WBRT group had significantly better KPS (Table I). However, they also had a significantly larger number of brain metastases. There was also a difference regarding median age (BSC: 57 years, WBRT 5 fractions: 53 years, WBRT 10 fractions: 55 years, p=0.048). Two different multivariate analyses of overall survival were performed to adjust for differences in baseline prognostic parameters. One included only the diagnosis-specific GPA as a surrogate of confounding prognostic imbalance and showed that both GPA (p=0.002) and WBRT (p=0.0001) influenced survival. The other one included all individual prognostic factors rather than GPA and showed that WBRT (p=0.008), KPS (p=0.0001), non-gastrointestinal cancer (p=0.03) and absence of extracranial metastases or involvement of maximum one organ (p=0.02) influenced survival. Female gender and number of brain metastases lost their significance in this model.

Discussion

The large randomized QUARTZ trial has previously shown that WBRT (5 fractions of 4 Gy) prolonged survival in patients with NSCLC who were younger than 60 years of age (hazard ratio=1.48) and those with GPA score of 2.5-3 points (hazard ratio=1.65). The subgroup with GPA score of 3.5-4 points was too small for meaningful analyses. Since many patients with brain metastases have primary tumors other than NSCLC additional evidence from mixed cohorts is required. Moreover, WBRT with higher total dose (10 fractions of 3 Gy) may in principle result in even better survival than WBRT with lower total dose. These considerations prompted us to perform the present retrospective study, which compares three different strategies: BSC, 5-fraction WBRT and 10-fraction WBRT in patients with favorable prognostic characteristics, as defined from the results of the QUARTZ trial.

Limitations of the present study include the limited number of patients, statistical power of subgroup analyses, and retrospective design. Fewer patients than anticipated were managed with BSC and 5-fraction WBRT. Nevertheless, the survival difference between these two groups, which persisted in the multivariate models, is in line with the findings from the QUARTZ trial. Interestingly, 10-fraction WBRT was not significantly better than 5-fraction WBRT. On the other hand, all long-term survivors belonged to the group with 10-fraction WBRT. In the absence of randomization, this finding may still be caused by selection bias and the fact that the WBRT regimens were assigned according to physicians' choice. In order to increase the statistical power, multivariate analyses were stratified by BSC or any WBRT, rather than three different strata. As a result of the patient selection criteria mentioned above, the present cohort was younger than generally observed in the literature (11-16).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Actuarial overall survival after BSC (RT 0, median 1.2 months), 5 fractions of WBRT (RT 20, median 3.2 months) and 10 fractions of WBRT (RT 30, median 3.9 months); log-rank test p-values: 0.05 (BSC versus 5 fractions), 0.0001 (BSC versus 10 fractions) and 0.18 (5 versus 10 fractions).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table I.

Patient characteristics.

Primary WBRT has recently become a rather controversial approach, especially in patients with better prognosis and/or limited number of brain metastases (17, 18). Advanced WBRT techniques with hippocampal sparing and dose escalation on visible brain metastases are under study and may eventually increase the acceptance of WBRT (19). On the other hand, focal stereotactic radiotherapy, which results in superior local control than conventional 10-fraction WBRT, will continue to play an important role. It is likely that improved prognostic models will impact on patient selection, both regarding the decision towards BSC in patients with poor prognostic features and the decision to recommend effective local treatment in other patients (20-23). The original diagnosis-specific GPA as used in the QUARTZ trial will soon be replaced by its new and refined variants (24, 25).

Conclusion

In line with the QUARTZ trial results, WBRT prolonged survival in patients with favorable prognostic features, defined as age younger than 60 years or diagnosis-specific GPA score 2.5-3 points.

Footnotes

  • Authors' Contributions

    CN participated in the design of the study and performed the statistical analysis. AD and AP collected patient data. CN, and AD conceived the study and drafted the article. All Authors read and approved the final article.

  • Conflicts of Interest

    The Authors declare that they have no competing interests regarding this study.

  • Received January 2, 2020.
  • Revision received January 10, 2020.
  • Accepted January 13, 2020.
  • Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved

References

  1. ↵
    1. Soffietti R,
    2. Kocher M,
    3. Abacioglu UM,
    4. Villa S,
    5. Fauchon F,
    6. Baumert BG,
    7. Fariselli L,
    8. Tzuk-Shina T,
    9. Kortmann RD,
    10. Carrie C,
    11. Ben Hassel M,
    12. Kouri M,
    13. Valeinis E,
    14. van den Berge D,
    15. Mueller RP,
    16. Tridello G,
    17. Collette L,
    18. Bottomley A
    : A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 31: 65-72, 2013. PMID: 23213105. DOI: 10.1200/JCO.2011.41.0639
    OpenUrlAbstract/FREE Full Text
    1. Bilger A,
    2. Bretzinger E,
    3. Fennell J,
    4. Nieder C,
    5. Lorenz H,
    6. Oehlke O,
    7. Grosu AL,
    8. Specht HM,
    9. Combs SE
    : Local control and possibility of tailored salvage after hypofractionated stereotactic radiotherapy of the cavity after brain metastases resection. Cancer Med 7: 2350-2359, 2018. PMID: 29745035. DOI: 10.1002/cam4.1486
    OpenUrlPubMed
  2. ↵
    1. Ampil F,
    2. Ellika S,
    3. Nanda A,
    4. Vora M
    : Long-term survival after stereotactic radiosurgery of brain metastases: A case series with 10-year follow-up. Anticancer Res 37: 5113-5115, 2017. PMID: 28870942. DOI: 10.21873/anticanres.11930
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Soffietti R,
    2. Abacioglu U,
    3. Baumert B,
    4. Combs SE,
    5. Kinhult S,
    6. Kros JM,
    7. Marosi C,
    8. Metellus P,
    9. Radbruch A,
    10. Villa Freixa SS,
    11. Brada M,
    12. Carapella CM,
    13. Preusser M,
    14. Le Rhun E,
    15. Rudà R,
    16. Tonn JC,
    17. Weber DC,
    18. Weller M
    : Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro Oncol 19: 162-174, 2017. PMID: 28391295. DOI: 10.1093/neuonc/now241
    OpenUrlCrossRefPubMed
    1. Nieder C,
    2. Guckenberger M,
    3. Gaspar LE,
    4. Rusthoven CG,
    5. De Ruysscher D,
    6. Sahgal A,
    7. Nguyen T,
    8. Grosu AL,
    9. Mehta MP
    : Management of patients with brain metastases from non-small cell lung cancer and adverse prognostic features: multi-national radiation treatment recommendations are heterogeneous. Radiat Oncol 14: 33, 2019. PMID: 30770745. DOI: 10.1186/s13014-019-1237-9
    OpenUrlCrossRefPubMed
  4. ↵
    1. Nieder C,
    2. Norum J,
    3. Hintz M,
    4. Grosu AL
    : Short survival time after palliative whole brain radiotherapy: Can we predict potential overtreatment by use of a nomogram? J Cancer 8: 1525-1529, 2017. PMID: 28775771. DOI: 10.7150/jca.18600
    OpenUrlCrossRefPubMed
  5. ↵
    1. Mulvenna P,
    2. Nankivell M,
    3. Barton R,
    4. Faivre-Finn C,
    5. Wilson P,
    6. McColl E,
    7. Moore B,
    8. Brisbane I,
    9. Ardron D,
    10. Holt T,
    11. Morgan S,
    12. Lee C,
    13. Waite K,
    14. Bayman N,
    15. Pugh C,
    16. Sydes B,
    17. Stephens R,
    18. Parmar MK,
    19. Langley RE
    : Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet 388: 2004-2014, 2016. PMID: 27604504. DOI: 10.1016/S0140-6736(16)30825-X
    OpenUrlCrossRefPubMed
  6. ↵
    1. Sperduto PW,
    2. Kased N,
    3. Roberge D,
    4. Xu Z,
    5. Shanley R,
    6. Luo X,
    7. Sneed PK,
    8. Chao ST,
    9. Weil RJ,
    10. Suh J,
    11. Bhatt A,
    12. Jensen AW,
    13. Brown PD,
    14. Shih HA,
    15. Kirkpatrick J,
    16. Gaspar LE,
    17. Fiveash JB,
    18. Chiang V,
    19. Knisely JP,
    20. Sperduto CM,
    21. Lin N,
    22. Mehta M
    : Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30: 419-425, 2012. PMID: 22203767. DOI: 10.1200/JCO.2011.38.0527
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Nieder C,
    2. Hintz M,
    3. Oehlke O,
    4. Bilger A,
    5. Grosu AL
    : The TNM 8 M1b and M1c classification for non-small cell lung cancer in a cohort of patients with brain metastases. Clin Transl Oncol 19: 1141-1146, 2017. PMID: 28357633. DOI: 10.1007/s12094-017-1651-0
    OpenUrlPubMed
  8. ↵
    1. Nieder C,
    2. Dalhaug A,
    3. Pawinski A
    : Serum lactate dehydrogenase contributes to prognostic assessment in patients with oligometastatic cancer and brain involvement. In Vivo 33: 229-232, 2019. PMID: 30587628. DOI: 10.21873/invivo.11464
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Jeene PM,
    2. de Vries KC,
    3. van Nes JGH,
    4. Kwakman JJM,
    5. Wester G,
    6. Rozema T,
    7. Braam PM,
    8. Zindler JD,
    9. Koper P,
    10. Nuyttens JJ,
    11. Vos-Westerman HA,
    12. Schmeets I,
    13. Niël CGHJ,
    14. Hutschemaekers S,
    15. van der Linden YM,
    16. Verhoeff JJC,
    17. Stalpers LJA
    : Survival after whole brain radiotherapy for brain metastases from lung cancer and breast cancer is poor in 6325 Dutch patients treated between 2000 and 2014. Acta Oncol 57: 637-643, 2018. PMID: 29276848. DOI: 10.1080/0284186X.2017.1418534
    OpenUrlPubMed
    1. Miyazawa K,
    2. Shikama N,
    3. Okazaki S,
    4. Koyama T,
    5. Takahashi T,
    6. Kato S
    : Predicting prognosis of short survival time after palliative whole-brain radiotherapy. J Radiat Res 59: 43-49, 2018. PMID: 29069502. DOI: 10.1093/jrr/rrx058
    OpenUrlPubMed
    1. Rades D,
    2. Dziggel L,
    3. Schild SE
    : A specific survival score for patients receiving local therapy for single brain metastasis from a gynecological malignancy. In Vivo 32: 825-828, 2018. PMID: 29936465. DOI: 10.21873/invivo.11314
    OpenUrlAbstract/FREE Full Text
    1. Rades D,
    2. Blanck O,
    3. Khoa MT,
    4. VAN Thai P,
    5. Hung NQ,
    6. Dziggel L,
    7. Schild SE
    : Validation of a survival score for patients receiving radiosurgery or fractionated stereotactic radiotherapy for 1 to 3 brain metastases. In Vivo 32: 381-384, 2018. PMID: 29475924. DOI: 10.21873/invivo.11249
    OpenUrlAbstract/FREE Full Text
    1. Saruwatari K,
    2. Ikeda T,
    3. Saeki S,
    4. Shingu N,
    5. Imamura K,
    6. Komatu T,
    7. Ushijima S,
    8. Maruyama H,
    9. Kashiwabara K,
    10. Tomita Y,
    11. Ichiyasu H,
    12. Fujii K,
    13. Sakagami T
    : Upfront cranial radiotherapy followed by erlotinib positively affects clinical outcomes of epidermal growth factor receptor-mutant non-small cell lung cancer with brain metastases. Anticancer Res 39: 923-931, 2019. PMID: 30711977. DOI: 10.21873/anticanres.13195
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Hansen HC,
    2. Janssen S,
    3. Thieme C,
    4. Perlov A,
    5. Schild SE,
    6. Rades D
    : Whole-brain radiotherapy (WBRT) for brain metastases: Does the interval between imaging and treatment matter? Anticancer Res 38: 6835-6840, 2018. PMID: 30504398. DOI: 10.21873/anticanres.13057
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Brown PD,
    2. Ahluwalia MS,
    3. Khan OH,
    4. Asher AL,
    5. Wefel JS,
    6. Gondi V
    : Whole-brain radiotherapy for brain metastases: Evolution or revolution? J Clin Oncol 36: 483-491, 2018. PMID: 29272161. DOI: 10.1200/JCO.2017.75.9589
    OpenUrlCrossRefPubMed
  12. ↵
    1. Andratschke N,
    2. Kraft J,
    3. Nieder C,
    4. Tay R,
    5. Califano R,
    6. Soffietti R,
    7. Guckenberger M
    : Optimal management of brain metastases in oncogenic-driven non-small cell lung cancer (NSCLC). Lung Cancer 129: 63-71, 2019. PMID: 30797493. DOI: 10.1016/j.lungcan.2018.12.009
    OpenUrlPubMed
  13. ↵
    1. Oehlke O,
    2. Wucherpfennig D,
    3. Fels F,
    4. Frings L,
    5. Egger K,
    6. Weyerbrock A,
    7. Prokic V,
    8. Nieder C,
    9. Grosu AL
    : Whole brain irradiation with hippocampal sparing and dose escalation on multiple brain metastases: Local tumour control and survival. Strahlenther Onkol 191: 461-469, 2015. PMID: 25592907. DOI: 10.1007/s00066-014-0808-9
    OpenUrlCrossRefPubMed
  14. ↵
    1. Nieder C,
    2. Marienhagen K,
    3. Dalhaug A,
    4. Aandahl G,
    5. Haukland E,
    6. Pawinski A
    : Prognostic models predicting survival of patients with brain metastases: integration of lactate dehydrogenase, albumin and extracranial organ involvement. Clin Oncol (R Coll Radiol) 26: 447-452, 2014. PMID: 24702741. DOI: 10.1016/j.clon.2014.03.006
    OpenUrlCrossRefPubMed
    1. Zindler JD,
    2. Jochems A,
    3. Lagerwaard FJ,
    4. Beumer R,
    5. Troost EGC,
    6. Eekers DBP,
    7. Compter I,
    8. van der Toorn PP,
    9. Essers M,
    10. Oei B,
    11. Hurkmans CW,
    12. Bruynzeel AME,
    13. Bosmans G,
    14. Swinnen A,
    15. Leijenaar RTH,
    16. Lambin P
    : Individualized early death and long-term survival prediction after stereotactic radiosurgery for brain metastases of non-small cell lung cancer: Two externally validated nomograms. Radiother Oncol 123: 189-194, 2017. PMID: 28237400. DOI: 10.1016/j.radonc.2017.02.006
    OpenUrlPubMed
    1. Nieder C,
    2. Dalhaug A,
    3. Pawinski A
    : External validation of the LabBM score in patients with brain metastases. J Clin Med Res 11: 321-325, 2019. PMID: 31019625. DOI: 10.14740/jocmr3746
    OpenUrlCrossRefPubMed
  15. ↵
    1. Lewitzki V,
    2. Klement RJ,
    3. Hess S,
    4. Kosmala R,
    5. Nieder C,
    6. Flentje M
    : External validation of a prognostic score predicting overall survival for patients with brain metastases based on extracranial factors. Clin Transl Radiat Oncol 16: 15-20, 2019. PMID: 30906886. DOI: 10.1016/j.ctro.2019.02.005
    OpenUrlPubMed
  16. ↵
    1. Sperduto PW,
    2. Deegan BJ,
    3. Li J,
    4. Jethwa KR,
    5. Brown PD,
    6. Lockney N,
    7. Beal K,
    8. Rana NG,
    9. Attia A,
    10. Tseng CL,
    11. Sahgal A,
    12. Shanley R,
    13. Sperduto WA,
    14. Lou E,
    15. Zahra A,
    16. Buatti JM,
    17. Yu JB,
    18. Chiang V,
    19. Molitoris JK,
    20. Masucci L,
    21. Roberge D,
    22. Shi DD,
    23. Shih HA,
    24. Olson A,
    25. Kirkpatrick JP,
    26. Braunstein S,
    27. Sneed P,
    28. Mehta MP
    : Estimating survival for renal cell carcinoma patients with brain metastases: an update of the Renal Graded Prognostic Assessment tool. Neuro Oncol 20: 1652-1660, 2018. PMID: 30418657. DOI: 10.1093/neuonc/noy099
    OpenUrlCrossRefPubMed
  17. ↵
    1. Sperduto PW,
    2. Jiang W,
    3. Brown PD,
    4. Braunstein S,
    5. Sneed P,
    6. Wattson DA,
    7. Shih HA,
    8. Bangdiwala A,
    9. Shanley R,
    10. Lockney NA,
    11. Beal K,
    12. Lou E,
    13. Amatruda T,
    14. Sperduto WA,
    15. Kirkpatrick JP,
    16. Yeh N,
    17. Gaspar LE,
    18. Molitoris JK,
    19. Masucci L,
    20. Roberge D,
    21. Yu J,
    22. Chiang V,
    23. Mehta M
    : Estimating survival in melanoma patients with brain metastases: An update of the graded prognostic assessment for melanoma using molecular markers (Melanoma-molGPA). Int J Radiat Oncol Biol Phys 99: 812-816, 2017. PMID: 29063850. DOI: 10.1016/j.ijrobp.2017.06.2454
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Anticancer Research: 40 (2)
Anticancer Research
Vol. 40, Issue 2
February 2020
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Anticancer Research.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Confirmatory Analysis of QUARTZ Study Results: Survival Prolongation After Whole-brain Radiotherapy
(Your Name) has sent you a message from Anticancer Research
(Your Name) thought you would like to see the Anticancer Research web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
3 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Confirmatory Analysis of QUARTZ Study Results: Survival Prolongation After Whole-brain Radiotherapy
CARSTEN NIEDER, ASTRID DALHAUG, ADAM PAWINSKI
Anticancer Research Feb 2020, 40 (2) 977-981; DOI: 10.21873/anticanres.14031

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Reprints and Permissions
Share
Confirmatory Analysis of QUARTZ Study Results: Survival Prolongation After Whole-brain Radiotherapy
CARSTEN NIEDER, ASTRID DALHAUG, ADAM PAWINSKI
Anticancer Research Feb 2020, 40 (2) 977-981; DOI: 10.21873/anticanres.14031
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Patients and Methods
    • Results
    • Discussion
    • Conclusion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Neurological Death After Radiotherapy for Brain Metastases: Role of the LabBM Score
  • Evaluation of Five Survival Scores in a Cohort of Elderly Patients With Cerebral Metastasis from Non-small Cell Lung Cancer
  • Google Scholar

More in this TOC Section

  • Bone Toxicity Case Report Combining Encorafenib, Cetuximab and WNT974 in a Phase I Trial
  • Assessment of Breakthrough Cancer Pain Among Female Patients With Cancer: Knowledge, Management and Characterization in the IOPS-MS Study
  • Low-dose Apalutamide in Non-metastatic Castration-resistant Prostate Cancer: A Case Series
Show more Clinical Studies

Similar Articles

Keywords

  • palliative radiotherapy
  • whole-brain radiotherapy
  • supportive care
  • brain metastases
  • prognostic factors
Anticancer Research

© 2025 Anticancer Research

Powered by HighWire