Is there a benefit in combining radiation treatments for patients with limited brain metastases?

This study examined the effectiveness of whole brain radiation therapy (WBRT) at treating non-small-cell lung cancer (NSCLC) that has spread to the brain. The trial focused on patients with few brain metastases (tumors that spread) and combined WBRT with stereotactic radiosurgery (SRS). The authors concluded that they did not find a benefit of combining the treatments and they recommended SRS alone for treating these patients.

Chemotherapy and surgery are not effective at treating NSCLC that has spread to the brain, therefore radiation is used. Typically, SRS is used as this delivers targeted radiation in high doses over fewer treatments. For patients with many tumors in the brain, it may be necessary to combine SRS with WBRT, which delivers radiation to the whole brain. Studies have been carried out to examine whether this combination therapy would also be beneficially to patients with fewer brain tumors (1-3) however results have been inconclusive. It is unknown whether specific patient populations would benefit from this combination therapy.

This trial examined whether SRS with WBRT improved survival in patients with NSCLC that has spread to the brain and have a good prognosis at diagnosis.

The trial included 126 patients who were followed up for an average of 14.2 months following treatment. Prognosis was predicted at diagnosis. 

There was no significant difference in overall survival (OS; time from treatment until death from any cause) between the two treatments. Patients with a good prognosis at diagnosis had an average OS of 11.3 months after SRS and WBRT, and 17.9 months with SRS alone. Patients with an unfavorable prognosis had an average OS of 3.7 months after SRS and WBRT, and 6.6 months after SRS alone.

The authors concluded that WBRT did not result in improved OS for patients with better prognosis at diagnosis. Furthermore, they state that this supports the use of SRS alone as treatment for patients with limited brain metastases. 

The authors did not include information of any side effects associated with the treatments.