Whole brain radiotherapy for patients with poor prognosis: possibilities for the impact of the QUARTZ trial

Whole brain radiotherapy (WBRT) has been a standard treatment in the management of patients with brain metastases since the initial report on the utility of WBRT by Chao in 1954 (1). However, the benefit of WBRT for patients with poor prognosis continues to be debated (2). The Medical Research Council’s (MRC’s) QUARTZ study (Quality of Life after Treatment for Brain Metastases) was designed to provide data regarding the impact of WBRT on quality of life for patients with metastatic non-small cell lung cancer and brain metastases with a poor prognosis and for whom benefit or lack of benefit of WBRT cannot be clearly defined (3). The trial has completed accrual, and results are expected to be reported in the coming months. However, the MRC took the unique step of releasing interim results in 2013 that did not show any hint of difference between quality of life and survival among patients who received WBRT, dexamethasone and optimal supportive care (OSC) versus dexamethasone and OSC alone (4); as we anticipate final results of this trial, it is worth reviewing the interim analysis in more detail and exploring the potential impact this study will have on the management of patients with poor prognosis and brain metastases.