Whole-brain RT no good for metastasized lung cancer

Whole-brain radiotherapy is of little benefit for patients whose lung cancer has spread to the brain -- despite its widespread use, according to a new study published online on 4 September in Lancet.

The findings suggest that these patients could be spared the potential harm of whole-brain radiotherapy, wrote the authors, led by Dr. Paula Mulvenna of Newcastle Hospitals National Health Service (NHS) Foundation Trust.

"Whole-brain radiotherapy was widely adopted into clinical practice based on the assumption it improves tumor control in patients with brain metastases," Mulvenna said in a statement released by Lancet. "But in our lung cancer clinics, we were not seeing the improvements we had hoped for in our patients. What's more, the technique's toxicity can be substantial, and it can damage cognitive function."

For the study, the researchers included 538 non-small cell lung cancer patients with brain metastases from 69 U.K. centers and three Australian centers treated between March 2007 and August 2014. Participants were randomly assigned to two treatment groups: best supportive care and dexamethasone, or best supportive care and dexamethasone plus whole-brain radiotherapy at 20 Gy in five daily fractions.

The group measured benefits of treatment in terms of quality-adjusted life years (QALYs), deciding that a reduction in QALYs of no more than seven days would mean that whole-brain radiotherapy should not be considered as standard care.

Patients in both groups lived a similar length of time after randomization with a similar quality of life, Mulvenna and colleagues found. Having one week of whole-brain radiation showed no benefit in the quality of life.

"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," concluded contributing author Dr. Ruth Langley in the Lancet statement.

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