Toward the clarification of the role of whole-brain radiation therapy for brain metastases from non-small cell lung cancer: a comment about the QUARTZ trial

In the September issue of Lancet, Mulvenna et al. reported the results of the QUARTZ trial, a phase 3 randomized clinical trial between supportive care (SC) only and SC plus whole-brain radiation therapy (WBRT) for patients with brain metastases (BMs) from non-small cell lung cancer (NSCLC), which is not indicated for stereotactic radiosurgery (SRS). The primary outcome measure was quality-adjusted life years (QALYs) and the second outcome measures include overall survival (OS). Mulvenna et al. found no significant difference in QALYs or OS between the two arms, and they concluded that “WBRT provides little additional clinically significant benefit for this patient group”. Mulvenna et al. should be lauded because the QUARTZ trial was the first sufficiently powered randomized clinical trial assessing the role of WBRT in addition to SC. However, we suspect that this categorical statement might be misleading and does not represent important findings which are not described in the report’s abstract. In order to thoroughly consider all of the important information in that report, we need to read it carefully step-by-step.