Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: MD, PhD Dieta Brandsma, Netherlands Cancer Institute
- Second opponent: Associate Professor Marianne Aanerud, University of Bergen
- Third member and chair of the evaluation committee: Professor Knut Stavem, University of Oslo
Chair of the Defence
Professor Emeritus Truls Hauge, University of Oslo
Principal Supervisor
MD, PhD Olav Erich Yri, Oslo University Hospital
Summary
Lung cancer is the second most common cancer globally, with non-small cell lung cancer (NSCLC) accounting for about 85% of the cases. Up to 40% of NSCLC patients develop brain metastases (BM) during their disease trajectory, which is often associated with poor survival. Radiotherapy is the main treatment modality for BM, with stereotactic radiotherapy (SRT) increasingly preferred over whole brain radiotherapy (WBRT) over the past 15 years, mainly due to better cognitive outcomes and with similar survival.
This thesis aimed to improve care for NSCLC patients with BM by identifying those unlikely to benefit from radiotherapy. A retrospective study (Paper 1) of more than 2,000 patients with BM from NSCLC treated 2006–2018 found increasing use of SRT. Fifty percent of patients treated with WBRT died within three months after start of radiotherapy. Older age, performance status 2 or worse, multiple brain metastases, and uncontrolled extracranial disease were associated with short survival.
A prospective study (Papers 2 and 3) including 294 patients confirmed these risk factors. In addition, patients with less than six months survival reported worse quality of life after radiotherapy compared to patients with survival more than six months regardless of treatment modality.
In conclusion, patients with short expected survival, especially those with poor performance status and uncontrolled extracranial disease, have limited benefits from radiotherapy. Consequently, they would be better served by abstaining from tumor-directed treatment and receiving palliative care alone, treating their symptoms and optimizing function and quality of life.
Additional information
Contact the research support staff.