Whole-brain radiotherapy (WBRT) provides “little additional clinically significant benefit” for patients with non–small cell lung cancer (NSCLC) with brain metastases, according to doctors performing the first large-scale randomized controlled trial of its kind.
As many as 30% of all patients with NSCLC will present with or develop brain metastases. There is currently a routine practice of giving WBRT in combination with steroids based mainly on older non-comparative studies. Currently improvements in neurosurgery and stereotactic radiosurgery have become more widely used than WBRT because they have fewer side effects.
The Quality of Life after Treatment for Brain Metastases (QUARTZ) study, were presented September 5 at the European Respiratory Society (ERS) International Congress 2016 and were simultaneously in Lancet.
The QUARTZ study is a comparative clinical trial that enrolled 538 patients from 2007 to 2014 at 69 United Kingdom and three Australian centers. Patients with advanced NSCLC who were unsuitable for surgical resection or stereotactic radiotherapy due to widespread metastases were treated with WBRT or optimal supportive care (OSC) and directly compared.
In the trial, there was no difference in overall survival or overall quality of life, between patients treated with OSC plus WBRT or those who received OSC alone. For the primary outcome measure of the study, quality-adjusted life-years (QALYs), which measures overall survival and quality of life the OSC alone group had 41.7 compared to 46.4 QALY days for the WBRT plus OSC group; WBRT conferred an advantage in terms of quality days, but only a small one.
Younger patients however fared better with WBRT experiencing an average overall survival of 10.4 weeks compared to 7.6 weeks for WBRT and OSC alone respectively in patients under 60 years of age. The authors also highlight a trend for better survival outcomes in fitter patients and in those with controlled primary NSCLC.
The results of the study suggest that WBRT is not beneficial in the majority of patients with widespread brain metastases who are otherwise poor candidates for radiosurgery. Patients younger than 60 years of age and those in otherwise good condition may however benefit from WBRT and patients should always discuss the pros and cons of each treatment with their physician.
Reference: 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: http://dx.doi.org/10.1016/S0140-6736(16)30825-X. Presented at the European Respiratory Society (ERS) International Congress September 5, 2016.