Stereotactic radiosurgery for brain metastases from small cell lung cancer without prior whole-brain radiotherapy: A meta-analysis

• Published in: Radiotherapy and oncology 2021-09, Vol.162, p.45-51
• Main Authors: Viani, G.A., Gouveia, A.G., Louie, A.V., Moraes, F.Y.
• Format: Article
• Language: English
• Subjects: Brain metastases; Lesion control; Meta-analysis; Overall survival; Small cell lung cancer; Stereotactic radiosurgery
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2021.06.026

•Stereotactic radiosurgery (SRS) as an upfront treatment for small cell lung cancer (SCLC) is controversial.•The meta-analysis showed a favorable outcome for local control and overall survival in high selected patients with SRS.•The salvage treatment of distant brain failures resulted in a reduced risk of neurological death.•These findings support the design of future randomized clinical trials. Assess upfront Stereotactic radiosurgery (SRS) effectiveness for small cell lung cancer (SCLC) brain metastases (BM). Where possible, a comparison with whole-brain radiotherapy (WBRT) was performed. Following PRISMA and MOOSE guidelines, eligible studies were identified on Medline, Embase, Cochrane Library, and proceedings of annual meetings between inception and July 01, 2020. Nine observational studies with 1638 patients were included. The median overall survival (OS) was 8.3 months (95% CI 7.1–9.5 months, I2 = 0%). OS rate at 12 months was 39% (95% CI 31–44%, I2 = 0%). The relative risk between SRS and WBRT for the OS at 12 months was 1.33 (95% CI 1.13–1.51, P = 0.0001). The projected OS for 6, 12, 18- and 24-months comparing SRS with WBRT was 67% vs. 57%, 39% vs. 29%, 22% vs. 15% and 15% vs 9%, favoring SRS (P