Most patients with non-small cell lung cancer which has spread to the brain could be spared whole brain radiotherapy as it makes little or no difference to how long they live and their quality of life. These are the conclusions of the QUARTZ
trial, the results of which were published today in The Lancet.
Around 45,500 people are diagnosed with lung cancer in the UK every year. An estimated 85 per cent of cases are non-small cell lung cancer. Up to 30 per cent of patients with non-small cell lung cancer have the disease spread to the brain.
Typically these patients are given steroids and supportive care, including palliative care and medications such as painkillers to manage their symptoms. They may also be offered whole brain radiotherapy daily for one to two weeks to improve symptoms. Before this trial, doctors had little evidence to prove whether giving these patients whole brain radiotherapy benefitted them.
Whole brain radiotherapy can cause side effects and involves daily visits to the hospital. The QUARTZ trial looked at whether patients could avoid whole brain radiotherapy without reducing either how long they were likely to live or the quality of their life.
The trial studied 538 patients from the UK and Australia. Half of the patients had whole brain radiotherapy and the other half did not. All the patients received steroids and supportive care.
The trial found no clear difference in survival and quality of life between the patients who did and didn't receive whole brain radiotherapy.
The patients who had whole brain radiotherapy lived on average around five days longer (9.2 weeks after entering the trial compared with 8.5 weeks for those who didn't receive radiotherapy), and reported around five more days of good quality life. This means that most patients could be spared the extra radiotherapy treatment, without a significant impact on either the length or quality of their life.
These results will help patients and doctors to make informed decisions based on understanding the level of benefit whole brain radiotherapy offers.
The QUARTZ trial was led by the MRC Clinical Trials Unit at UCL and took place at hospitals throughout the UK, and a small number of hospitals in Australia. The trial was funded by Cancer Research UK.