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WSJ shines light on harms of whole-brain radiation for cancer that spreads to the brain

New Study Questions Use of Whole-Brain Radiation to Treat Cancer

Our Review Summary

Patient lying under a linear accelerator or linac for cancer radiation therapy

The story reports on a study that found the use of “whole-brain” radiation therapy in conjunction with targeted radiation therapy to treat cancer in the brain has more adverse side effects and no appreciable benefits over the use of targeted radiation therapy alone. The story does a good job of explaining the relevant treatments and placing the work in context. It reads clearly and gives readers an appreciation for the clinical treatment issues and concerns. However, there are areas where it could have been more informative — such as quantifying the results of the study and noting where it got some of its numbers regarding the prevalence of brain tumors.

 

Why This Matters

We are entering an era of medical research where we no longer only focus on survival, but on patient-centered outcomes such as quality of life. Cancer that has spread to the brain can be particularly difficult to treat, and whole-brain radiation treatment can have side-effects — such as seizures and memory loss — that counterbalance the potential survival benefits. The National Cancer Institute (NCI) estimates that as many as 170,000 Americans may develop tumors in the brain each year from cancers that began in other parts of the body. Research that can inform clinical decision-making on how to treat these cancers — and improve the odds that patients can maintain their quality of life — is well worth reporting on.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

The story doesn’t mention cost. It’s a missed opportunity to discuss the costs associated with whole brain radiation and the savings that could be had by avoiding it.

But since the story is focused entirely on not pursuing a course of action — and there’s no additional treatment specified in place of whole-brain radiation that would involve costs — we won’t dock points for this omission. We’ll rule it Not Applicable.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story notes that patients who received whole-brain radiation “performed significantly worse” three months after treatment on memory and verbal communication tests, as well as scoring lower on a quality of life questionnaire. However, the story doesn’t tell us what “significantly worse” means, nor does it say how much lower the quality of life scores were. The story also doesn’t tell us if all of the relevant patients scored lower, or if there was a significant amount of variation in terms of patient response. Because the relevant study is not available for review (it was presented at a conference), and the story doesn’t link to the relevant study abstract, it’s difficult or impossible for readers to look up these details.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The potential harm in this case would be that, by avoiding whole-brain radiation, a patient may shorten his or her life. The story addresses this. For example, the story does a good job of articulating differences in overall survival for those who received whole-brain radiation and targeted therapy versus those who only received targeted therapy — and it gets bonus points for explaining that the observed differences in survival time were not statistically significant. The story also quotes one source as saying that there are some circumstances in which whole-brain radiation may still be beneficial.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story does a fine job of explaining the size and design of the study, as well as the relevant treatments.

Does the story commit disease-mongering?

Satisfactory

We had a healthy debate within our review team as to whether the story should be flagged here. The story says that brain metastases affect “an estimated 400,000 to 600,000 patients annually in the U.S. alone.” It’s not clear where this number comes from. According to the NCI, “it has been estimated that 98,000 to 170,000 new cases [of brain metastases] are diagnosed in the United States each year.” These numbers fall well below the “400,000 to 600,000” cited in the story.

That being said, the story is likely referring to the number of living people in the U.S. who have been diagnosed with brain metastases at some point, which could easily amount to 400,000 to 600,000. But the wording is not clear on that point, and we think many readers will assume the story is talking about new cases each year. We’ll give the benefit of the doubt as we usually do in these cases, but we wish that the story had given a citation for these numbers and clarified that the numbers were for prevalent disease (anyone living with the condition), not new cases. Brain cancer is sufficiently scary without throwing around large, unsourced numbers.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story clearly identifies the lead author of the study when quoting him and cites two additional experts who have no affiliation with the study.

Does the story compare the new approach with existing alternatives?

Not Applicable

We’ll rate this Not Applicable. The story deals entirely with focused vs. whole-brain radiation and doesn’t discuss other approaches to brain cancer such as surgery or chemotherapy. But radiation is the standard of care for brain metastases (the main focus of the story), so we don’t feel that the story should be expected to discuss those other treatments. Had the story mentioned the fact that radiation is the standard of care in this situation, we would award a Satisfactory. But since no mention is made either way, the best the story can do is Not Applicable.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story makes clear that whole-brain radiation treatment was prevalent for many years and is now declining in popularity.

Does the story establish the true novelty of the approach?

Satisfactory

The story cites one independent source as saying that this is the “most comprehensive study that lets us quantify the risk/benefit” of whole-brain radiation treatment. However, the story would have been stronger if it had addressed some of the other research going on in regard to whole-brain radiation treatment. As this 2013 paper notes, concerns over the toxic effects of whole-brain radiation treatment have prompted a lot of studies in recent years. A quick search of ClinicalTrials.gov found more than 30 open studies on whole-brain radiation, so this is clearly an area of high interest to the research community. Even a cursory discussion of recent and ongoing work in the field would have made the story stronger.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does have some similarities to a release from the American Society of Clinical Oncology, but that may be because the reporter was watching the same panel that the release was covering. The story certainly incorporates information not included in the release.

Total Score: 7 of 8 Satisfactory

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