Radiosurgery alone is associated with favorable outcomes for brain metastases from small-cell lung cancer

Lung Cancer : Journal of the International Association for the Study of Lung Cancer
Tyler P RobinChad G Rusthoven

Abstract

Whole-brain radiation therapy (WBRT) is the standard approach for brain metastases (BM) arising in patients with small-cell lung cancer (SCLC), but the neurocognitive toxicities of WBRT are well documented. For this reason, stereotactic radiosurgery (SRS) alone is the preferred modality for limited BM in most histologies, but in SCLC there are few data exploring this approach. We queried the National Cancer Database (NCDB) for patients with SCLC with BM at diagnosis and stratified by upfront SRS compared with upfront WBRT ± SRS. We utilized multivariate Cox regression and propensity score matching (PSM) to determine the impact on overall survival (OS) of each approach. 5952 eligible patients (WBRT: 5752; SRS: 200) were identified from 2010 to 2014 with a median follow-up of 40.0 months. Upfront SRS was associated with superior OS (median 10.8 vs 7.1 months, HR 0.65, 95% CI 0.55-0.75, p < 0.001), which persisted on multivariate analysis controlling for comorbidities, extracranial metastases, age, race/ethnicity, and gender (HR 0.70, 95% CI 0.60-0.81, p < 0.001). These results were confirmed in PSM analysis. A subset analysis comparing outcomes after SRS vs SRS + WBRT showed no differences in OS (p = .601). To our knowledge, this...Continue Reading

Citations

Nov 11, 2019·Clinical & Experimental Metastasis·Mustafa S AschaJill S Barnholtz-Sloan
Apr 10, 2020·Journal of Neurosurgical Sciences·Boryana M EastmanJerome J Graber
Aug 11, 2020·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Chad G RusthovenPaul D Brown
Oct 26, 2018·Frontiers in Oncology·Tyler P Robin, Chad G Rusthoven
Jun 24, 2019·Journal of Neuro-oncology·Andrew FaramandL Dade Lunsford
Aug 15, 2020·Neuro-oncology Advances·Joshua D PalmerDavid Roberge
Jun 6, 2020·Clinical & Experimental Metastasis·Sumanth P ReddyEdward Pan
Dec 10, 2020·Clinical and Translational Radiation Oncology·Ian PereiraHina Saeed
May 14, 2021·International Journal of Radiation Oncology, Biology, Physics·Hayeon KimJohn A Vargo
Jun 26, 2021·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·G A VianiF Y Moraes
Oct 11, 2021·American Journal of Clinical Oncology·Rebekah RittbergDavid E Dawe
Mar 17, 2019·World Neurosurgery·Greg BowdenEdward Monaco
Dec 22, 2021·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Michael A VogelbaumDavid Schiff

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