Inoperable brain metastases from non-small cell lung cancer: what part does whole brain radiotherapy play in standard treatment?

Brain metastases from NSCLC are, sadly, all too common. They have a devastating effect on quality of life and functional ability and median survival of patients with unresectable disease is between 2 and 3 months. It is not clear whether whole brain radiotherapy adds anything to the quality or length of survival of such patients and a randomised clinical trial has just begun which is designed to address this issue. It is essential that the QUARTZ trial recruits as many eligible patients as possible if the results are to be meaningful. Patients with inoperable brain metastases from NSCLC should be discussed at a lung cancer multidisciplinary meeting. This provides an opportunity to debate the likely benefit of WBRT in each individual case and if there is uncertainty then entry into QUARTZ should be considered.