Giving whole brain radiotherapy to patients whose lung cancer has spread to their brain provides no additional clinical benefit over steroids and best supportive care. These results from the QUARTZ trial were presented at the American Society of Clinical Oncology Annual Meeting on 31 May 2015.
Non small cell lung cancer that has spread to the brain is often treated by giving whole brain radiotherapy, alongside supportive care including steroids. But there was no randomised controlled trial evidence to show that this approach is better than giving best supportive care (including steroids). Supportive care means treatment and physical care given to control cancer symptoms and reduce the side effects of cancer treatments. A course of whole brain radiotherapy usually involves one week of daily visits to hospital (excluding weekends). It can help improve some symptoms, but it does cause side effects, so doctors and patients need to know whether this is worth it.
The QUARTZ trial was designed to see if patients could be treated as effectively without whole brain radiotherapy. As the life expectancy of these patients is poor, researchers wanted to look at the effects on quality of life as well as length of life. To do this, they looked at quality adjusted life years, which combines the length and quality of life into one measure. The researchers felt that whole brain radiotherapy should remain standard treatment if best supportive care alone reduced the average quality adjusted life year by more than one week.
The trial found that there was no significant difference in how long people lived. The average overall survival was 65 days for people who had whole brain radiotherapy, and 57 days for those who had best supportive care alone. There was also no major difference in quality adjusted life years. The average quality adjusted life years was 43 days in those who had whole brain radiotherapy, and 41 days in those who had best supportive care alone.
Having one week of radiotherapy only increased the average quality adjusted life years by two days. The trial showed that best supportive care alone gave between nine days fewer and seven days more quality adjusted life years than whole brain radiotherapy. These results will help patients and doctors to make informed decisions based on understanding of the level of benefit whole brain radiotherapy offers.
The trial took place in hospitals in the UK and Australia. 538 people whose lung cancer had spread to their brain took part. Every week the researchers asked people taking part in the trial, and their carers, about their quality of life and symptoms they were experiencing.
Lung cancer is the second most common cancer in the UK, with more than 43,000 new cases in 2011. Nine out of every 10 of these cases are of the ‘non small cell’ type, which were investigated in this trial. The cancer spreads to the brain in four out of every 10 people treated for non small cell lung cancer.