Radiation Oncology/SCLC/Brain Metastases

Small Cell Brain Metastases Overview

 * Small cell lung cancer brain metastases have historically been treated with first line whole brain radiation therapy (WBRT)
 * Small cell lung cancer patients were excluded from the landmark randomized trials that established the strategy of SRS alone for limited brain metastases

Stereotactic Radiosurgery

 * FIRE-SCLC (1994–2018) PMID 32496550 -- "Evaluation of first-line radiosurgery vs whole-brain radiotherapy for small cell lung cancer brain metastases: the FIRE-SCLC cohort study" (Rusthoven CG,JAMA Oncology. 2020, epub Jun 4)
 * Retrospective. 710 patients treated with first-line SRS without prior PCI or WBRT
 * Median OS 8.5 months (1 lesion = 11 mo, 2-4 lesions = 8.7 mo, 5-10 lesion = 8.0 mo, 11+ lesions = 5.5 mo)
 * Median time to CNS progression 8.1 months
 * On comparison with propensity-score matched dataset of first-line WBRT, WBRT was associated with improved time to CNS progression (HR, 0.38; P < .001), without an improvement in overall survival (median, 6.5 mo for SRS vs 5.2 mo for WBRT; P = .003)
 * Conclusion: "Results of this study suggest that the primary trade-offs associated with SRS without WBRT, including a shorter time to CNS progression without a decrease in overall survival, are similar to those observed in settings in which SRS is already established."


 * Review of SRS in SCLC: PMID: 32776807 -- "Radiosurgery for Small-Cell Brain Metastases: Challenging the Last Bastion of Preferential Whole-Brain Radiotherapy Delivery" (Journal of Clinical Oncology, epub August 2020)