Multi-institutional retrospective review of stereotactic radiosurgery for brain metastasis in patients with small cell lung cancer without prior brain-directed radiotherapy

Joseph A Miccio; Andrew Barsky; Sarah Gao; Vivek Verma; Sonal S Noticewala; Vikram Jairam; Skyler B Johnson; James B Yu; James E Hansen; Sanjay Aneja; Yi An; Roy H Decker; S Bulent Omay; Jing Li; Goldie A Kurtz; Michelle Alonso-Basanta; John Y K Lee; Veronica L Chiang; Henry S Park

Multi-institutional retrospective review of stereotactic radiosurgery for brain metastasis in patients with small cell lung cancer without prior brain-directed radiotherapy

J Radiosurg SBRT. 2020;7(1):19-27.

Authors

Joseph A Miccio¹, Andrew Barsky², Sarah Gao¹, Vivek Verma³, Sonal S Noticewala⁴, Vikram Jairam¹, Skyler B Johnson⁵, James B Yu¹, James E Hansen¹, Sanjay Aneja^{1

6}, Yi An¹, Roy H Decker¹, S Bulent Omay⁷, Jing Li⁴, Goldie A Kurtz², Michelle Alonso-Basanta², John Y K Lee⁷, Veronica L Chiang⁸, Henry S Park¹

Affiliations

¹ Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06511, USA.
² Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
³ Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
⁴ Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, TX 77030, USA.
⁵ Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
⁶ Center for Outcomes Research and Evaluation (CORE) Yale School of Medicine, New Haven, CT 06511, USA.
⁷ Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
⁸ Department of Neurosurgery, Yale School of Medicine, New Haven, CT, 06511, USA.

PMID: 32802575
PMCID: PMC7406345

Abstract

Introduction: Patients with small cell lung cancer (SCLC) brain metastasis (BM) typically receive whole brain radiotherapy (WBRT) as data regarding upfront radiosurgery (SRS) in this setting are sparse. Methods: Patients receiving SRS for SCLC BM without prior brain radiation were identified at three U.S. institutions. Overall survival (OS), freedom from intracranial progression (FFIP), freedom from WBRT (FFWBRT), and freedom from neurologic death (FFND) were determined from time of SRS. Results: Thirty-three patients were included with a median of 2 BM (IQR 1-6). Median OS and FFIP were 6.7 and 5.8 months, respectively. Median FFIP for patients with ≤2 versus >2 BM was 7.1 versus 3.6 months, p=0.0303. Eight patients received salvage WBRT and the 6-month FFWBRT and FFND were 87.8%. and 90.1%, respectively. Conclusions: Most SCLC patients with BM who received upfront SRS avoided WBRT and neurologic death, suggesting that SRS may be an option in select patients.

Keywords: Stereotactic radiosurgery; brain metastasis; small cell lung cancer; survival.