Lung cancer is the most common primary site of brain cancers Whole brain radiotherapy (WBRT) is commonly used to treat brain metastases (BM) from non-small cell lung cancer (NSCLC). However, a recent randomized trial (QUARTZ)1 showed that its omission did not significantly impact the survival or quality of life of their patients recruited from UK and Australian centers. As a result, utility of WBRT is increasingly being questioned Are their study findings applicable in our population known to have high rates of mutation for epidermal...

Medical records of patients who received WBRT in two tertiary hospitals in Singapore over 18 months were reviewed. Characteristics and survival outcomes of patient with NSCLC receiving WBRT for the first time were evaluated. Patients with prior excision of BM or stereotactic radiotherapy were excluded. Those who received prophylactic cranial irradiation in the absence of disease in the brain parenchyma or leptomeninges were also not included. Treatment details including radiotherapy dose and use of tyrosine kinase inhibitors (TKI) were recorded. Survival of patient was calculated...

Between January 2015 and June 2016, 116 patients with NSCLC received WBRT for their BM. Their median age was 65 years (range 36-85) and median follow up duration was 110 days (range: 14-840). 106 (92%), four (3%) and six patients (5%) had adenocarcinoma, squamous cell carcinoma and others in histology respectively. 102 (88%) had their driver mutation tested of which 59 (58%) were epidermal growth factor receptor (EGFR) mutants. 113 (97%) had extracranial metastases 20 (17%) had solitary BM Median survival was 115 days Factors...

Our patient population has considerable differences in characteristics and better survival outcomes after WBRT compared to those recruited into the QUARTZ trial. Further prospective studies should be done to evaluate the value of WBRT in our population.

Ivy is a currently a registrar at theNational University Cancer Institute, Singapore (NCIS).

Mulvenna P, Nankivell M, Barton R, Faivre-Finn C, Wilson P, McColl E et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. The Lancet. 2016;388(10055):2004-2014.