Radiotherapy for Lung Cancer That Has Spread to the Brain

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Non-small-cell lung cancer is the most common cause of metastatic brain disease, and whole-brain radiation therapy along with steroids has been widely used to prolong survival and improve quality of life in those patients.

However, there has been no strong evidence to determine whether this approach is better than supportive care alone.

To provide clarity, investigators recruited 538 patients from 2007 to 2014 with lung cancer metastases to the brain to participate in the Quality of Life After Treatment for Brain Metastases (QUARTZ) trial. Patients received optimal supportive care plus whole-brain radiation therapy or optimal supportive care alone.

Average survival for patients assigned to supportive care plus whole-brain radiation therapy was 64.4 days compared with 59.5 days for the group that received supportive care only.

The researchers also assessed the patients’ combined length and quality of life (quality-adjusted years of life, or QALY) and found a difference of just 4.7 days in favor of the whole-brain radiation therapy group. The rate of serious adverse side effects was similar in both groups, most commonly infections and neurologic or pulmonary problems.

The QUARTZ researchers concluded that whole-brain radiation therapy provides little additional benefit, and omitting it does not affect quality of life or survival. One possible exception: The investigators note that for patients younger than age 60, whole-brain radiation therapy might offer a survival advantage.

Source: LANCET, published online, Sept. 4, 2016