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First-Line Stereotactic Radiosurgery vs Whole-Brain Radiotherapy for SCLC Brain Metastases


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In a cohort analysis reported in JAMA Oncology, Rusthoven et al found that first-line stereotactic radiosurgery was associated with similar outcomes as whole-brain radiotherapy in patients with small cell lung cancer (SCLC) brain metastases.

"We believe that these data provide a benchmark for stereotactic radiosurgery outcomes and offer support to first-line stereotactic radiosurgery as a treatment option in carefully selected patients with small cell lung cancer.”
— Rusthoven et al

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As stated by the investigators, “Although stereotactic radiosurgery is preferred for limited brain metastases from most histologies, whole-brain radiotherapy has remained the standard of care for patients with small cell lung cancer. Data on stereotactic radiosurgery are limited.”

Study Details

The study included data from 710 patients from the FIRE-SCLC cohort study who received stereotactic radiosurgery without prior prophylactic cranial irradiation or whole-brain radiotherapy between 1994 and 2018, and data from a contemporary dataset including 219 patients who received whole-brain radiotherapy between 2003 and 2015.

Key Findings

In the stereotactic radiosurgery cohort, median overall survival was 8.5 months, median time to central nervous system (CNS) progression (TTCP) was 8.1 months, and median CNS progression-free survival was 5.0 months. Median overall survival was 11.0 months in patients with 1 lesion, 8.7 months for 2–4 lesions, 8.0 months for 5–10 lesions, and 5.5 months for ≥ 11 lesions.

On unadjusted analysis, median overall survival was improved with stereotactic radiosurgery vs whole-brain radiotherapy (5.2 months; P < .001), with a significant difference persisting on multivariate analysis (hazard ratio [HR] = 1.48, P < .001). Unadjusted median TTCP was better with whole-brain radiotherapy (median = not reached, P < .001), with the significant difference persisting on multivariate analysis (HR = 0.38, P < .001). Unadjusted median CNS progression-free survival was better with stereotactic radiosurgery vs whole-brain radiotherapy (3.8 months, P = .03), with the difference not persisting on multivariate analysis (HR = 0.91, P = .35).

On propensity score-matched analysis including 187 patients in each group, whole-brain radiotherapy was associated with improved TTCP (median = not reached vs 9.0 months, P < .001), stereotactic radiosurgery was associated with improved overall survival (median = 6.5 vs 5.2 months, P = .003), and no difference in CNS progression-free survival was observed (median = 4.0 months for stereotactic radiosurgery vs 3.8 months for whole-brain radiotherapy, P = .79).

The investigators concluded: “…We believe that the outcomes of stereotactic radiosurgery for small cell lung cancer were encouraging overall and were particularly impressive for patients with a single brain metastasis. In addition, the trade-offs inherent to a first-line stereotactic radiosurgery approach without whole-brain radiotherapy, including a shorter time to CNS progression without an associated decrease in overall survival, appear to be similar to those in other settings in which stereotactic radiosurgery is already well-established. We believe that these data provide a benchmark for stereotactic radiosurgery outcomes and offer support to first-line stereotactic radiosurgery as a treatment option in carefully selected patients with small cell lung cancer.”

Chad G. Rusthoven, MD, of the University of Colorado School of Medicine, Department of Radiation Oncology, Aurora, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.


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