Whole brain radiotherapy for lung cancer brain metastases: little clinical benefit demonstrated

A study published recently in The Lancet,  led by researchers from the Medical Research Council Clinical Trials Unit at University College London (London, UK), has demonstrated that whole brain radiotherapy (WBRT) has little clinical benefit for patients with non-small-cell lung cancer (NSCLC) that has spread to the brain.

Lung cancer is known to be the most common cause of brain metastases, with 30% of NSCLC patients going on to subsequently present brain metastases. Despite there being a lack of clinical trial evidence to support its clinical benefit, WBRT is often used for these patients.

In the recent Quality of Life after Treatment for Brain Metastases (QUARTZ) study, researchers recruited 538 NSCLC patients with brain metastases deemed to be unsuitable for stereotactic radiotherapy or surgical resection. These patients were randomly assigned to receive either optimal supportive care alone, comprising only dexamethasone treatment, or optimal supportive care, which included both dexamethasone and WBRT.

Overall, the researchers demonstrated that those patients receiving WBRT experienced more side effects, including drowsiness, hair loss and nausea. They also highlighted that there was no significant difference in the overall survival, quality of life or dexamethasone use between the two groups.  A small difference was observed in the quality-adjusted life-years for the group receiving WBRT; however, the researchers believe that this small difference does not translate into a sufficient clinical benefit to warrant WBRT’s frequent use.

First author Paula Mulvenna (Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust, UK) commented on the findings: “This trial is changing treatment for patients. Before the QUARTZ trial clinicians weren’t certain that giving WBRT enhanced our patient’s quality of life, but did frequently offer it in good faith. These results confirm we can safely omit this treatment and concentrate on other ways of ensuring our patients and their families receive the best end of life care.”

Sources:  Mulvenna P, Nankivell M, Barton R et al. 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. The Lancet doi:10.1016/S0140-6736(16)30825-X (2016) (Epub ahead of print); www.cancerresearchuk.org/about-us/cancer-news/press-release/2016-09-04-lung-cancer-patients-whose-tumour-has-spread-to-the-brain-could-be-spared-radiotherapy