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Re-evaluating the Role of Whole Brain Radiotherapy for Brain Metastases From Non-small Cell Lung Cancer in the
1Oncology, University Hospital of Wales, Cardiff University, Cardiff, GBR.
Background:
The role of whole brain radiotherapy (WBRT) in non-small cell lung cancer (NSCLC) brain metastases is increasingly debated in the era of immunotherapy, with much research suggesting that its use provides little benefit for this cohort of patients.
Methods:
A retrospective cohort study included patients diagnosed with NSCLC and brain metastases (2017-2020, n=147). Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed, and a two-tailed p-value of <0.05 was considered statistically significant.
Results:
Median survival was 9.7 months, with average survival being 15.9 months from the time of diagnosis. Patients who received immunotherapy lived for 31.5 months, while those who did not lived for 14.7 months. Patients who received WBRT + immunotherapy lived an average of 19.5 months, and those who received WBRT lived an average of 10.2 months. Immunotherapy (hazard ratio (HR) 0.48, p<0.001) and stereotactic radiotherapy (SRS) (HR 0.62, p<0.001) were independently associated with improved survival. WBRT alone was associated with poorer outcomes.
Conclusion:
WBRT alone provides limited benefit; immunotherapy and SRS improve survival and should be prioritized in future clinical practice.
