Whole brain radiotherapy in patients with metastatic breast cancer – is there a need to be selective?

Purpose: The QUARTZ trial [1] changed practice for whole brain radiotherapy (WBRT) in non-small cell lung cancer. For brain metastases in breast cancer, practice varies across institutions. Most patients having WBRT only survive a few months [2], so, considering side effects can last weeks, could WBRT be used more selectively? With the increasing use of focal brain radiotherapy (SRS), WBRT is used less though evidence suggests WBRT provides better tumour control [3,4].The ability to prognosticate patients prior to WBRT is therefore essential.