Whole Brain Radiotherapy Is Useless

Cancer is bad news for any person, especially so if it has metastasized to the brain. One of the most common therapies for such patients, whole brain radiotherapy (WBRT), is used despite there being not much evidence for its helpfulness. Publishing their results on 4th September, Paula Mulvenna and colleagues have finally exposed that neither does WBRT prolong the total lifespan in patient with a grave prognosis, nor does it enhance their quality of life.

Dr Paula is an oncologist at Newcastle Hospital and her research team comprised of experts from the UK and Australia. The scientists stated that there was only one prior research conducted in the field and it hinted ‘limited benefits’ of WBRT, which were not enough to explain the current widespread use of the therapy.

Hence, Dr Paula and group conducted the current research, involving patients with a serious prognosis as they are the most likely to get the treatment. The research comprised of patients who solely got the brain metastases from non-small cell lung cancer (NSCLC).

This recent finding got published in the journal The Lancet. The study involved a total of 538 NSCLC. It was a clinical phase 3 non-inferiority study, as not giving the standard treatment to patients would have raised ethical questions. Half of them, 269, were assigned the regular optimal supportive care (OSC) with the steroid dexamethasone and WBRT. While the other half received OSC and the steroid, but not the WBRT.

The investigators observed that their hypothesis regarding the uselessness of the therapy did not hold for all categories of patients. Their qualitative analysis hinted that the therapy was useful for patients less than 60 years old. However, the authors admitted that this qualitative analysis was not of statistical significance.

During the study, the scientists further learned that the preconception among the medical community that WBRT can help in sparing steroid dose was simply not true. Their subjects, who were on WBRT, did not show a substantial reduction in steroid medication intake.

When discussing the overall impact of their findings, Paula and co-authors wrote that theirs’s is a definitive paper on the utility of WBRT in comparison to OSC, and that further studies should not explore avenues involving WBRT. They suggested new treatments be tested in combination with OSC. The current paper had its hands tied behind the back as the nature of the severe prognosis of the participants involved limits the amount to inference an investigator can gather.

In a comment paper published in the same journal, The Lancet, Cécile Le Pechoux, Frederic Dhermain and Benjamin Besse appreciated the work of the UK and Australian scientists. The French reviewers from the Gustave Roussy Cancer Campus remarked that the study had a sample size large enough for the results to be reliable. The commenter posed the question: “Should we then consider that there is no place for WBRT in such a group of patients with NSCLC because it gives little, if any, additional clinically significant benefit?”

Discussing the limitations of the study, the reviewers pointed out that due to the short lifespan of the participants, the investigators possibly could not have properly recorded the symptoms and simply did not have the time to observe a decline in steroid consumption. The French writers answered their above mentioned question themselves: “Yes, we believe that optimized WBRT, given at the right time to appropriate patients, could lead to more individualized strategies.”

Cancer is the second leading cause of death in America and lung cancer in particular takes 1.6 million lives around the globe, each year. A quarter of these people will eventually develop a brain metastasized caner. Since these cancer cells originate form the lungs, as in the case of NSCLC derived metastases, radiotherapy is used as lung cancer tissue shows radio-sensitivity.

However, WBRT has severe side effects like dementia and a loss of mental ability but because majority of the patients die, the complete list of all the drawbacks is not known. Meanwhile, what is known is the cost of WBRT to be massive, around $17,500. Hence when it comes to lung cancer, caution is clearly better than cure.

The CDC website reports: “The most important thing you can do to lower your lung cancer risk is to quit smoking and avoid secondhand smoke.” Smoking is notorious for being the cause of lung cancer and it happens to be so with a good reason, as 80 to 90% of lung cancer cases are linked to smoking.

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