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

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)