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January 05, 2017

The Changing Role of Whole-Brain RadiotherapyDemise or Time for Selective Usage?

Author Affiliations
  • 1Miami Cancer Institute, Miami, Florida
  • 2Niigata University, Niigata, Japan
  • 3Northwestern Medicine Cancer Center, Warrenville, Illinois
JAMA Oncol. Published online January 5, 2017. doi:10.1001/jamaoncol.2016.5414

Is there a role for whole-brain radiation therapy in the treatment of brain metastases?—Yes.

Whole-brain radiotherapy (WBRT), has been integral in the management of brain metastases (BrM), but some recent trials have raised important questions regarding WBRT.

In the QUARTZ trial,1 538 patients with non–small-cell lung cancer (NSCLC) BrM were randomized to WBRT or best supportive care. No survival difference was observed (8-9 weeks median overall survival [OS] for both). The obvious conclusion from is that WBRT does not prolong median OS in NSCLC BrM, but the caveat here is the dismal median OS of 8 to 9 weeks, implying selection of an extremely unfavorable cohort of patients, best considered for hospice. They also found no difference in quality of life (QOL). It takes weeks before WBRT translates to clinical benefit and QOL improvement. When more than half the patients die within 8 weeks, there is not enough time for QOL benefit to manifest, underscoring the existing practice that for patients with poor performance status and short survival, best supportive care is ideal, not a practice-changing observation.

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