Patients with non-small cell lung cancer and brain metastasis can be spared whole brain radiotherapy (WBRT), as it does little or has no effect on survival and quality of life, according to a study published in The Lancet.
Whole brain radiotherapy in combination with steroids is widely used when treating patients with brain metastases, but the data supporting this approach are based mainly on reports from the 1950s and the prognosis of these patients remains poor. Therefore, investigators led by Paula Mulvenna, FRCR, Northern Centre for Cancer Care (Newcastle upon Tyne, United Kingdom), conducted a clinical trial with the aim of establishing whether WBRT could be omitted without negatively impacting survival or quality of life.
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Between March 2, 2007 and August 29, 2014, 538 patients with NSCLC that had metastasized into the brain were recruited to participate in the trial and randomly assigned to receive optimal supportive care (OSC) plus WBRT or OSC alone. OSC alone was considered non-inferior if it was no worse than 7 quality-adjusted-life-years (QALYs) worse than treatment with WBRT plus OSC.
Overall, the estimated difference in QALYs was -4.7 days without WBRT. Similarly, there was only a 0.7 week difference in median survival between the two groups. Patients who were treated with WBRT also experienced significantly more episodes of drowsiness, hair loss, nausea, and dry or itchy scalp compared with patients treated with OSC alone; however, the rate of serious adverse events was consistent across both groups.
Researchers concluded that omitting WBRT does not significantly impact QALY or overall survival and could actually increase the frequency with which patients experience low-grade adverse events.
“A long-held belief is that treatment with WBRT allows patients to reduce and stop treatment with steroids,” authors of the study wrote. “In our trial, the addition of WBRT to OSC was not associated with a significant reduction in dexamethasone dose or use in the first 8 weeks from randomisation, and challenges the dogma that WBRT can be seen as a potential steroid-sparing modality.”
However, researchers did not collect any further quality-of-life data outside of adverse events, which they acknowledged as a limitation of the study. Some of these factors will be discussed in a separate publication.
