Lung cancer patients whose disease has spread to the brain could be spared potentially harmful whole brain radiotherapy.
People whose lung cancer has spread to the brain could be spared the brain radiotherapy because the treatment offers no benefit at the advanced stage of cancer, new research suggests.
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Clinical trials have showed that whole brain radiotherapy is no better than any other treatment for lung cancer patients in terms of extending life or improving quality of life.
Radiotherapy is the most common treatment for destroying cancerous tumors despite the fact there is strong evidence to support this treatment in all lung cancer patients. Moreover, the treatment can lead to a cascade of side-effects such as fatigue, nausea, neurotoxicity. So, it was necessary to test the effectiveness of the treatment in lung cancer patients and to avoid its usage if it is not offering any benefits.
“Whole brain radiotherapy was widely adopted into clinical practice based on the assumption it improves tumor control in patients with brain metastases. But in our lung cancer clinics, we were not seeing the improvements we had hoped for in our patients,” said lead author Dr Paula Mulvenna from the Northern Centre for Cancer Care in Newcastle, UK.
“Survival times are poor and have hardly changed since 1980s. What’s more, the technique’s toxicity can be substantial and it can damage cognitive function.”
To assess the effectiveness of whole brain radiotherapy, researchers recruited more than 500 patients with secondary tumors (when the cancer has spread to the brain) and divided them into two group. One group was treated with whole brain radiotherapy while the other received steroid and supportive care.
Upon completion of the trial, researchers found no clear difference in survival and quality of life between the patients who did and didn’t receive whole brain radiotherapy. Patients in both groups lived for around same length of time after the end of clinical trial, 64.4 days whole brain radiotherapy group vs. 59.5 days best supportive on average. Plus, both experienced almost same 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,” said Professor Ruth Langley from the Medical Research Council Clinical Trials Unit at University College London.
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“Overtime, there has been a shift away from using whole brain radiation in favor of radiosurgery, which has minimal side effects. Our result could further restrict its use. In the future, potential new treatments should be assessed in addition to best supportive care rather than in addition to, or in place of, whole brain radiotherapy.”