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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…

Overview of attention for article published in The Lancet, October 2016
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522

About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (92nd percentile)

Citations

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141 Dimensions

Readers on

mendeley
274 Mendeley
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1 CiteULike
Title
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
Published in
The Lancet, October 2016
DOI 10.1016/s0140-6736(16)30825-x
Pubmed ID
Authors

Paula Mulvenna, Matthew Nankivell, Rachael Barton, Corinne Faivre-Finn, Paula Wilson, Elaine McColl, Barbara Moore, Iona Brisbane, David Ardron, Tanya Holt, Sally Morgan, Caroline Lee, Kathryn Waite, Neil Bayman, Cheryl Pugh, Benjamin Sydes, Richard Stephens, Mahesh K Parmar, Ruth E Langley

Abstract

Whole brain radiotherapy (WBRT) and dexamethasone are widely used to treat brain metastases from non-small cell lung cancer (NSCLC), although there have been no randomised clinical trials showing that WBRT improves either quality of life or overall survival. Even after treatment with WBRT, the prognosis of this patient group is poor. We aimed to establish whether WBRT could be omitted without a significant effect on survival or quality of life. The Quality of Life after Treatment for Brain Metastases (QUARTZ) study is a non-inferiority, phase 3 randomised trial done at 69 UK and three Australian centres. NSCLC patients with brain metastases unsuitable for surgical resection or stereotactic radiotherapy were randomly assigned (1:1) to optimal supportive care (OSC) including dexamethasone plus WBRT (20 Gy in five daily fractions) or OSC alone (including dexamethasone). The dose of dexamethasone was determined by the patients' symptoms and titrated downwards if symptoms improved. Allocation to treatment group was done by a phone call from the hospital to the Medical Research Council Clinical Trials Unit at University College London using a minimisation programme with a random element and stratification by centre, Karnofsky Performance Status (KPS), gender, status of brain metastases, and the status of primary lung cancer. The primary outcome measure was quality-adjusted life-years (QALYs). QALYs were generated from overall survival and patients' weekly completion of the EQ-5D questionnaire. Treatment with OSC alone was considered non-inferior if it was no more than 7 QALY days worse than treatment with WBRT plus OSC, which required 534 patients (80% power, 5% [one-sided] significance level). Analysis was done by intention to treat for all randomly assigned patients. The trial is registered with ISRCTN, number ISRCTN3826061. Between March 2, 2007, and Aug 29, 2014, 538 patients were recruited from 69 UK and three Australian centres, and were randomly assigned to receive either OSC plus WBRT (269) or OSC alone (269). Baseline characteristics were balanced between groups, and the median age of participants was 66 years (range 38-85). Significantly more episodes of drowsiness, hair loss, nausea, and dry or itchy scalp were reported while patients were receiving WBRT, although there was no evidence of a difference in the rate of serious adverse events between the two groups. There was no evidence of a difference in overall survival (hazard ratio 1·06, 95% CI 0·90-1·26), overall quality of life, or dexamethasone use between the two groups. The difference between the mean QALYs was 4·7 days (46·4 QALY days for the OSC plus WBRT group vs 41·7 QALY days for the OSC group), with two-sided 90% CI of -12·7 to 3·3. Although the primary outcome measure result includes the prespecified non-inferiority margin, the combination of the small difference in QALYs and the absence of a difference in survival and quality of life between the two groups suggests that WBRT provides little additional clinically significant benefit for this patient group. Cancer Research UK, Medical Research Council Clinical Trials Unit at University College London, and the National Health and Medical Research Council in Australia.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 274 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Argentina 2 <1%
Japan 2 <1%
United States 1 <1%
Hong Kong 1 <1%
Spain 1 <1%
Canada 1 <1%
Unknown 266 97%

Demographic breakdown

Readers by professional status Count As %
Researcher 69 25%
Other 43 16%
Student > Master 34 12%
Student > Postgraduate 25 9%
Student > Doctoral Student 19 7%
Other 84 31%
Readers by discipline Count As %
Medicine and Dentistry 191 70%
Unspecified 38 14%
Nursing and Health Professions 10 4%
Agricultural and Biological Sciences 7 3%
Biochemistry, Genetics and Molecular Biology 5 2%
Other 23 8%

Attention Score in Context

This research output has an Altmetric Attention Score of 522. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 November 2018.
All research outputs
#12,506
of 12,380,418 outputs
Outputs from The Lancet
#288
of 30,349 outputs
Outputs of similar age
#759
of 265,524 outputs
Outputs of similar age from The Lancet
#31
of 431 outputs
Altmetric has tracked 12,380,418 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 30,349 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 31.9. This one has done particularly well, scoring higher than 99% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 265,524 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 431 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 92% of its contemporaries.