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For patients with lung cancer brain metastases unsuitable for surgery or radiosurgery, whole-brain radiotherapy added no meaningful survival or quality of life compared with steroids and supportive care alone.
Non-inferiority phase 3 trial of 538 patients with brain metastases from non-small-cell lung cancer unsuitable for resection or stereotactic radiotherapy, randomised to optimal supportive care with dexamethasone with or without whole-brain radiotherapy (20 Gy in five fractions).
Quality-adjusted life years were 46.4 days with radiotherapy and 41.7 days without, a difference within the non-inferiority margin, and overall survival was about nine weeks in both arms.
Whole-brain radiotherapy is not a default for poor-prognosis brain metastases; supportive care alone is an acceptable choice, with radiotherapy reserved for selected younger, fitter patients.