Around 30% of non-small cell lung cancer NSCLC) patients will present or develop with brain metastases. For a long time doctors have given radiotherapy to the whole brain to try and alleviate potential symptoms, improve quality of life and maybe increase survival. The results of this trial suggest that whole brain radiotherapy does not improve on these things and indeed might even make quality of life worse.
So importantly we have now found out that whole brain radiotherapy for this group of patients is not necessary. But why is this important?
Radiotherapy treatment involves daily visits to a radiotherapy department. In the Quartz trial this involved one visit per day for 5 days.
Visiting a radiotherapy department can sometimes be a logistical nightmare for our patients. Parking is difficult, and sometimes expensive. A lot of our cancer centres are not blessed with good public transport links, and getting lifts might mean someone taking time off work. For many patients coming daily for radiotherapy can be quite an expensive outlay, sandwiches are bought, cups of coffee are bought, parking paid for, bus fare and so on. So knowing that a visit is no longer necessary will actually reduce this stress for a good many people.
Radiotherapy also involves side effects. Brain irradiation can cause the hair on the head to fall out. The brain and associated tissues within the skull will swell, causing headaches and sometimes a feeling of nausea, and sometimes vomiting. The scalp may get red , dry and itchy. Furthermore patients may experience general lethargy. This might be result of the radiotherapy but it is also exacerbated by the daily chore of visiting the radiotherapy department.
So it is a win for the patient but it is also a win for the NHS. Money is saved, and the over-burdened radiotherapy department can use their time treating people that will benefit from the treatment.