Primary or salvage stereotactic radiosurgery for brain metastatic small cell lung cancer

• Published in: Journal of neuro-oncology 2019-08, Vol.144 (1), p.217-225
• Main Authors: Faramand, Andrew, Niranjan, Ajay, Kano, Hideyuki, Flickinger, John, Lunsford, L. Dade
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain cancer; Brain diseases; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Brain tumors; Clinical Study; Diagnosis; Female; Follow-Up Studies; Humans; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Neurology; Oncology; Prognosis; Prospective Studies; Radiation therapy; Radiosurgery; Radiosurgery - mortality; Retrospective Studies; Salvage Therapy; Small cell lung carcinoma; Small Cell Lung Carcinoma - pathology; Small Cell Lung Carcinoma - surgery; Survival Rate
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-019-03224-w

Purpose We evaluated the outcomes after stereotactic radiosurgery (SRS) for patients who developed new or progressive brain disease regardless of whether they had no prior radiation, PCI, or WBRT. Methods We retrospectively identified 90 SCLC patients who had SRS between 1991 and 2018. Thirty-one patients had no evidence of brain disease at the time of initial diagnosis but received prophylactic cranial irradiation. Twenty-six without initial brain disease underwent delayed SRS after brain disease was identified. Seventeen patients with synchronous systemic and brain disease underwent WBRT at the time of diagnosis. Fifteen patients had brain disease detected at the time of initial diagnosis and had initial SRS. Results We found no difference in overall survival between patients who received initial PCI or WBRT compared to patients treated with SRS alone at the time when brain metastases were identified. PCI was not associated with a longer duration between initial diagnosis and the development of brain metastasis. Local tumor control was achieved in 49 out of 58 patients who had follow up MRI available for review (84.5%). Actuarial local tumor control at 3, 6, and 12 months was calculated as 92%, 85%, and 80%, respectively. Radiation therapy (PCI or WBRT) before SRS was not associated with better or worse local tumor control. Conclusion In this experience neither prior PCI nor WBRT improved survival or local tumor control in SCLC patients who underwent SRS for new or recurrent brain disease.