International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationStereotactic Radiosurgery for Patients With Brain Metastases From Small Cell Lung Cancer
Introduction
Lung cancer is the most common cause of cancer mortality worldwide in both men and women (1). Furthermore, lung cancer is the most common source of brain metastasis (2). Small-cell lung cancer (SCLC) accounts for about 10–15% of all lung cancers and occurs predominantly in smokers (3). Although only 10% of patients with SCLC will have brain metastases at diagnosis, the cumulative incidence at 2 years is approximately 50% 4, 5, 6. For this reason, many patients with SCLC receive prophylactic cranial irradiation (PCI), which appears to reduce the incidence of delayed brain metastases and lengthen overall survival (OS) 7, 8. Treatment options for brain metastases include surgical resection, whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), or a combination of these options 9, 10, 11, 12, 13, 14. There are few data in the literature on the experience and efficacy of SRS in the management of brain metastases from SCLC (15). This study updates our institution’s experience using radiosurgery as a treatment option for brain metastases from SCLC.
Section snippets
Methods and Materials
Forty-four patients with brain metastases from a histologically proven primary SCLC underwent SRS between July 1991 and June 2008. Thirty patients were female and 14 were male. The median patient age was 63 years (range, 38–84 years). The median Karnofsky performance status (KPS) at time of treatment was 80 (range, 50–100). Twenty-four patients (55%) had active systemic disease at the time of SRS. The median time to development of brain metastases was 8.5 months from initial diagnosis (range,
Results
The median follow-up from gamma knife SRS in this patient population was 9 months (range, 1–49 months). Thirty-nine (89%) of the 44 patients had died by time of analysis. Five patients died from their systemic disease and 2 had their deaths attributed to intracranial disease. The remaining 32 patients died from unknown or undocumented causes. The median OS in this series was 9 months from time of SRS (Fig. 1).
Multivariate testing using the Cox proportional hazards model revealed two factors
Discussion
Brain metastases are the most common type of intracranial tumor (21). They frequently occur in patients with SCLC and are found in approximately 10% of patients at the time of cancer diagnosis. More than 50% of patients will develop brain spread at 2 years 4, 5, 6. Because of such a high incidence, PCI has been advocated to reduce the development of brain metastases and to lengthen overall survival in patients 5, 7, 22. After brain spread is confirmed, with supportive care and steroids alone
Conclusions
This study represents the largest series of patients with brain metastases from SCLC treated with SRS. The results presented indicate that SRS provided safe and effective local tumor control in patients with metastatic brain lesions from SCLC. Despite aggressive treatment with SRS, these patients still remain at a high risk of distant brain failure. This study does not address the potential role of SRS with or without salvage SRS compared to the role of PCI or WBRT, a possible area for future
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Cited by (82)
Stereotactic Radiosurgery for Brain Metastases in Patients With Small Cell Lung Cancer
2023, Advances in Radiation OncologyShould Stereotactic Radiosurgery Be Considered for Salvage of Intracranial Recurrence after Prophylactic Cranial Irradiation or Whole Brain Radiotherapy in Small Cell Lung Cancer? A Population-Based Analysis and Literature Review
2020, Journal of Medical Imaging and Radiation SciencesCitation Excerpt :10% cannot complete the full prescribed course of ReRT [13,14]. One-third do not report ReRT side effects [13]; however, the irreversible neurocognitive decline risked with one course of WBRT is likely to be exaggerated after ReRT [28,32]. Overall, repeat WBRT is unlikely to offer durable control [17].
Conflict of interest: Drs. Lunsford and Kondziolka are consultants for Elekta; however, no funds from Elekta were used to perform this study. Dr. Lunsford is also a stockholder in Elekta.