Whole brain radiotherapy, or WBRT, provides little benefit to patients whose lung cancer has spread to the brain, findings of a new study have revealed.
Researchers found that patients with non-small cell lung cancer (NSCLC) who received WBRT did not have significant improvements in the survival times and quality of life compared with those who received standard care.
The study, which was published in the journal The Lancet, sought to investigate if giving WBRT to patients with lung cancer that has spread to the brain can affect quality of life and survival compared to giving optimized care but without radiotherapy.
Whole brain radiotherapy comes with substantial side effects such as fatigue, nausea and neurotoxicity but it is widely used. There has been no clear evidence, however, that shows it is better compared with best supportive care alone when it comes to prolonging life or improving the quality of life.
Study researcher Paula Mulvenna, from the Newcastle Hospitals NHS Foundation Trust, said that WBRT was thought to control tumors but oncologists have not seen improvements that they hoped to see in their lung cancer patients.
Survival times are considered poor and hardly changed since three decades ago. Mulvenna also said that the toxicity of the technique can be substantial and can potentially damage cognitive function.
For the study, Mulvenna and colleagues involved 538 patients with NSCLC and brain metastases who were at least 18 years old. The researchers randomly assigned the patients to receive either best supportive care and dexamethasone, or best supportive care, dexamethasone and WBRT.
The results showed that regardless of the treatment received, patients had a poor survival rate of about nine weeks.
Although radiotherapy is not painful, it can be time-consuming and involves multiple visits to the hospital. The result of the study suggests that there is a need to reconsider this treatment approach since it can be deemed cruel for patients to go through the side effects and hassles associated with the treatment when life expectancy is already short. The treatment though may still benefit younger patients.
The findings only apply to patients with non-small cell cancers, which means that the treatment may still be beneficial to other groups of patients.
"In summary, [our study] provides compelling information for clinicians and patients alike; for younger patients, WBRT might offer a survival advantage, but for all other groups, omitting WBRT does not significantly affect QALY or overall survival," Mulvenna and colleagues wrote in their study.