Whole brain radiotherapy for brain metastases from non-small cell lung cancer: the end of an era?

Up to 30−50% of patients with non-small cell lung cancer (NSCLC) will at some point in their course of disease develop brain metastases (1,2). In selected patients, local aggressive treatment in the form of surgery or radiosurgery may be indicated; however, particularly patients with large volume metastatic brain disease have traditionally been treated with whole brain radiotherapy (WBRT). Although the general belief is that WBRT results in symptom palliation, decrease of steroid needs and even survival prolongation, up till now the evidence for such benefit of WBRT over best supportive care has been largely lacking, with the exception of a small Radiation Therapy Oncology Group (RTOG) study in the early 1980’s (3).