Whole brain radiotherapy in patients with NSCLC and brain metastases

NSCLC management in 2016 still represents a real challenge because detectable brain metastases might be responsible for life-threatening symptoms and serious impairment of quality of life, possibly ameliorated with WBRT.7 Mulvenna and colleagues are to be congratulated for conducting this non-inferiority phase 3 trial assessing the omission of WBRT in patients with NSCLC and brain metastases.5 They chose quality-adjusted life-years (QALYs) as the primary outcome measure, and a group of 538 patients between 2007 and 2014 were randomly assigned to receive either WBRT (20 Gy in five daily fractions) and optimal supportive care, including dexamethasone (n=269), or optimal supportive care alone (n=269).