Whole brain radiotherapy (WBRT) adds no value to length or quality of survival in patients with metastatic non-small cell lung cancer (NSCLC), according to a new study.
Researchers at Newcastle Hospitals NHS Foundation Trust (Newcastle upon Tyne, United Kingdom), University College London (UCL, United Kingdom), and other institutions recruited 538 NSCLC adult patients with brain metastases between March 2007 and August 2014. Study participants were randomly assigned to receive best supportive care and dexamethasone, or best supportive care, dexamethasone, and WBRT (20 Gy in five daily fractions).
Benefits of treatment were measured in terms of quality adjusted life years (QALYS), which combines length and quality of life (evaluated during weekly telephone assessments). By October 2015, 536 patients had died (267 in the WBRT group and 269 in the best supportive care alone group); patients in both groups lived a similar length of time after randomization (about two months). The difference between the groups in terms of average QALYs was just 4.7 days.
Hardly any differences in steroid use or serious adverse events were reported in either group, although more episodes of drowsiness, hair loss, nausea and dry/itchy scalp were reported by WBRT patients. The researchers concluded that while WBRT may be beneficial in patients who are younger than 60 years old, it should no longer be considered standard treatment for the majority of patients with NSCLC that has spread to the brain. The study was presented at the annual European Respiratory Society meeting, held during September 2016 in London (United Kingdom).
“Whole brain radiotherapy was widely adopted into clinical practice based on the assumption it improves tumor control in patients with brain metastases. But in our lung cancer clinics, we were not seeing the improvements we had hoped for in our patients,” said lead author consultant clinical oncologist Paula Mulvenna, MD. “Survival times are poor and have hardly changed since the 1980s. What's more, the technique's toxicity can be substantial and it can damage cognitive function.”
“Whole brain radiotherapy cannot be considered as the standard treatment for all patients with brain metastases because it does not extend survival, improve quality of life, or reduce steroid use,” said senior author Professor Ruth Langley, PhD, of UCL. “In the future, potential new treatments (whether using drugs or stereotactic radiotherapy techniques) should be assessed in addition to best supportive care rather than in addition to, or in place of, whole brain radiotherapy.”