Research questions whole brain radiotherapy for older lung cancer patients
Older lung cancer patients whose disease has spread to the brain could be spared potentially harmful radiotherapy, new research indicates.
University of Queensland researcher Dr Tanya Holt said the international study – published this week in The Lancet – showed that 'whole brain radiotherapy' (WBRT) had no benefit to the length or quality of life in non-small cell lung cancer (NSCLC) patients aged over 60.
Dr Holt said WBRT was used widely for tumour control, but it had significant side-effects including fatigue, hair loss and nausea, in addition to toxicity that could damage cognitive function and memory.
"This research shows that WBRT may be beneficial in patients who are younger than 60, but it should not be standard treatment for the majority of older patients with non-small cell lung cancer that has metastasised to the brain," she said.
Patients who received WBRT survived only five days longer overall, compared to a group of patients who received 'supportive care' and steroids to minimise tumour-related symptoms.
"There were no clear differences in the number of serious adverse events reported in both groups, although in WBRT patients, more episodes of drowsiness, hair loss, nausea, and dry/itchy scalp were reported," she said.
The clinical trial involved more than 500 patients (with an average age of 66) with advanced lung cancer in Australia and the United Kingdom, and was led by Dr Paula Mulvenna from Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne.
An estimated 12,200 new lung cancer diagnoses will be made in Australia this year, and almost a third of all non-small cell cases will eventually spread to the brain.
"The prognosis for these patients is poor, and survival times for the majority have improved little since the 1980s," Dr Holt said.
"Patients with NSCLC need to discuss all treatment options and their own circumstances with their oncologists, and weigh up the possible side-effects as well as the potential benefits of all treatments."
The research was funded by Cancer Research UK and in Australia by the National Health and Medical Research Council (NHMRC).
The findings have been presented at a meeting of the European Respiratory Society in London.
More information: Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. press.thelancet.com/lungcancer.pdf
