Best Supportive Care Versus Whole-Brain Irradiation, Chemotherapy Alone, or WBRT Plus Chemotherapy in Patients With Brain Metastases From Small-Cell Lung Cancer: A Case-Controlled Analysis

Abstract

BackgroundWBRT and systemic chemotherapy are the mainstay treatments for small-cell lung cancer (SCLC) brain metastases (BM). However, current recommendations are mainly based on evidence from retrospective analyses. A recent randomized trial found no benefits from WBRT compared with best supportive care (BSC) in patients with more than three BM from non-small-cell lung cancer (NSCLC). Herein, we aimed to evaluate the roles of WBRT and chemotherapy further in the management of BM from SCLC.Materials and MethodsThere were 698 patients with BM from SCLC included. Of these, 580 received anti cancer treatment (Group 1), including 178 who received WBRT only (Group 1a), 129 who received chemotherapy only (Group 1b), and 273 who received WBRT plus chemotherapy (Group 1c). The other 118 received BSC (Group 2). Propensity score matching (PSM) analysis was used to compare Group 2 with each of the other groups.ResultsAfter PSM, compared with Group 2 (n = 118), patients in Group 1 (n = 440) had a prolonged overall survival (OS) in both univariate and multivariate tests, with a median survival time of 10 months (95% CI = 9−11) in Group 1 and 3.5 months (95% CI = 2−7) in Group 2 (p < 0.001). In subgroup analyses, patients who received WBRT plus chemotherapy were more likely to benefit from treatment (p < 0.001). Chemotherapy alone or WBRT alone did not show survival benefits.ConclusionWBRT plus chemotherapy improved OS in patients with BM from SCLC as compared to BSC. Chemotherapy alone and WBRT alone did not show survival benefits. This retrospective study suggests that SCLC patients with BM who receive WBRT combined with chemotherapy have a better outcome than those receiving BSC alone.

Analysis of Immunotherapy Combined with Radiotherapy in Patients with Brain Metastasis of Driver Gene-Negative Non-Small-Cell Lung Cancer

“…[ 24 ]. After WBRT, local radiotherapy for NSCLC patients with brain metastasis can reduce the treatment target volume, improve the tumor control rate, reduce local recurrence and the occurrence of intracranial new tumors, and relieve the clinical symptoms of patients to some extent [ 25 ].…”

The Impact of Chemosensitivity on the Outcome of Brain Metastases in Small-Cell Lung Cancer: A Retrospective Analysis

“…For patients with a limited number of BMs, an additional radiation boost to WBRT or SRT can be recommended [ 16 , 17 ]. Several studies have suggested that the occurrence of BMs is a sign of systemic failure of tumor control; therefore, the treatment of BMs should focus on chemoradiotherapy [ 20 , 21 , 22 ]. A respective study in 2021 observed that the combination of WBRT and etoposide-platinum agents could prolong OS in SCLC patients with BMs [ 21 ].…”

“…Several studies have suggested that the occurrence of BMs is a sign of systemic failure of tumor control; therefore, the treatment of BMs should focus on chemoradiotherapy [ 20 , 21 , 22 ]. A respective study in 2021 observed that the combination of WBRT and etoposide-platinum agents could prolong OS in SCLC patients with BMs [ 21 ]. However, another prospective trial did not obtain similar results [ 23 ].…”

Parotid metastases from primary lung cancer: Case series and systematic review of the features

“…In other words, patients with lung cancer parotid metastasis seem to show a greater tendency of brain metastasis. Previous studies concluded that WBRT ( 60 , 61 ), stereotactic radiosurgery (SRS) ( 62 , 63 ), and prophylactic cranial irradiation (PCI) ( 62 , 64 , 65 ) can improve the prognosis of these patients and bring survival benefits. Therefore, for patients for whom brain metastasis already appears, WBRT or SRS should be performed as soon as possible.…”