Patients with small cell lung cancer (SCLC) that has metastasized to the brain were safely and successfully treated with targeted stereotactic radiation (SRT) rather than whole-brain radiation therapy (WBRT) in a phase II trial, demonstrating the practicality of a less-invasive approach for patients with limited brain metastases. Findings from the study were recently published in the Journal of Clinical Oncology.
“Despite being the historical standard, [WBRT] might not be necessary for all patients,” stated first author Ayal Aizer, MD, MHS, Director of Central Nervous System Radiation Oncology at Brigham and Women’s Hospital. “Our findings demonstrate that targeted, brain-directed radiation may be a viable treatment for patients with limited brain metastases from [SCLC] and potentially spare them from the side effects of [WBRT].”
Study Methods and Rationale
Although WBRT is known to cause significant long-term adverse effects, it is still the standard approach for patients with SCLC and brain metastases due to a lack of prospective data supporting stereotactic approaches and concerns for neurologic death without whole-brain radiation.
Investigators from Mass General Brigham conducted a single-arm, multicenter phase II trial to explore possible neurologic death rates for patients with SCLC and brain metastases when receiving SRT compared with historical WBRT controls. Patients were eligible for the study if they had 1 to 10 brain metastases. Prior brain-directed radiation therapy was not allowed in the study.
A total of 100 patients were enrolled in the study between February 2018 and April 2023. Participants had a median of two brain metastases.
Key Study Findings
A total of 20 neurologic deaths and 64 non-neurologic deaths were reported with SRT. The median overall survival was 10.2 months and only 22% of patients required salvage WBRT.
The neurologic death rate was 11.0% at 12 months (95% confidence interval [CI] = 5.8%–18.1%); the historical rate for patients managed with WBRT was 17.5% at 12 months.
“These results support a shift toward more personalized, targeted treatment approaches that can help maintain quality of life while effectively managing brain metastases,” Dr. Aizer said. “By avoiding [WBRT] in select patients, we may be able to improve quality of life and reduce cognitive side effects without compromising outcomes.”
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
