The effect of whole brain radiotherapy is minimal? Experts question: rashly discarding is not wise
About 30% of lung cancer patients have symptoms of brain metastases during the course of the disease. After a brain metastasis, does the patient receive palliative care or receive whole brain radiotherapy to gain long-term survival? At the second session of the Yangtze River Forum on Lung Cancer held recently, this topic has become a hot spot for experts and scholars. It is reported that there are 1.8 million new cases of lung cancer every year in the world, and about 30% of patients will have brain metastases. Brain metastases occur in adenocarcinoma and small cell lung cancer. Whole brain radiotherapy is the standard treatment for multiple brain metastases. Recently, a research report published in The Lancet (QUARTZ study) puts a "challenge" on the status of whole brain radiotherapy. This report is aimed at whole brain radiotherapy in patients with multiple brain metastases from non-small cell lung cancer. Researchers believe that the role of whole brain radiotherapy in this part of the patient is minimal. This research has sparked extensive discussions in the industry. Wu Kailiang, an expert in radiation therapy at the Affiliated Tumor Hospital of Fudan University, said in an interview that the study had defects in the selection of quality of life scale, dose pattern of whole brain radiotherapy, population composition ratio, and data set selection, and rashly abandoned the whole brain. Radiation therapy is not wise. He believes that the genetic mutation spectrum of lung cancer in Chinese population is significantly different from that in Europe and the United States. It is unscientific to use the results of European and American studies to guide Chinese clinical practice. Wu Kailiang told reporters that the overall effective rate of whole brain radiotherapy for multiple brain metastases is about 30%-40%. In some special populations, such as patients with EGFR gene-sensitive mutations, the efficiency of whole brain radiotherapy is 70%-80%, and the combined use of targeted drugs is more efficient. The expert said that in China, the proportion of EGFR mutations is about 40% in lung adenocarcinoma. This means that more patients in China may benefit from whole brain radiotherapy. Wu Kailiang pointed out that we should individualized treatment of patients with lung cancer brain metastasis, according to the patient's age, general physical condition, number of brain metastases, extracranial tumor control, EGFR mutation and other factors, to explore the best treatment mode of different subgroups. Source: Zhongxin Net
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It is reported that at present, patients with multiple brain metastases who have long-term survival after whole brain radiotherapy can often be observed clinically. In general, patients younger than 60 years old, in good physical condition, and with good primary tumor control can benefit from whole brain radiotherapy, and all patients with non-small cell lung cancer who are not suitable for surgery or stereotactic radiotherapy will have brain metastases. It is not wise to give up whole brain radiotherapy. 
