Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases

Rusthoven, Chad G.; Yamamoto, Masaaki; Bernhardt, Denise; Smith, Derek E.; Gao, Dexiang; Serizawa, Toru; Yomo, Shoji; Aiyama, Hitoshi; Higuchi, Yoshinori; Shuto, Takashi; Akabane, Atsuya; Sato, Yasunori; Niranjan, Ajay; Faramand, Andrew; Lunsford, L. Dade; McInerney, James; Tuanquin, Leonard; Zacharia, Brad E.; Chiang, Veronica; Singh, Charu; Yu, James B.; Braunstein, Steve; Mathieu, David; Touchette, Charles J; Lee, Cheng‐Chia; Yang, Huai Che; Aizer, Ayal A.; Cagney, Daniel; Chan, Michael D.; Kondziolka, Douglas; Bernstein, Kenneth; Silverman, Joshua; Grills, I.S.; Siddiqui, Z.A.; Yuan, Justin C.; Sheehan, Jason P.; Cordeiro, Diogo; Nosaki, Kename; Seto, Takahashi; Deibert, Christopher P.; Verma, Vivek; Day, Samuel E.; Halasz, Lia M.; Warnick, Ronald E.; Trifiletti, Daniel M.; Palmer, Joshua D.; Attia, Albert; Li, Benjamin; Cifarelli, Christopher P.; Brown, Paul D.; Vargo, John A.; Combs, Stephanie E.; Kessel, Kerstin A.; Rieken, Stefan; Patel, Samir; Gückenberger, Matthias; Andratschke, Nicolaus; Kavanagh, Brian D.; Robin, Tyler P.

doi:10.1001/jamaoncol.2020.1271

Cited by 152 publications

(103 citation statements)

References 39 publications

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“…217,218 While brain metastases arising from small-cell lung cancer have historically been treated with WBRT, an international retrospective study suggested that SRS may be suitable in some cases. 219 Some brain metastases of radioresistant primary tumors such as melanoma and renal cell carcinoma have also been shown to achieve good local control with SRS. 220 Other predictors of longer survival with SRS include younger age, good PS, and primary tumor control.…”

Section: Surgerymentioning

confidence: 99%

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Nabors

Portnow

Ahluwalia

et al. 2020

Journal of the National Comprehensive Cancer Network

350

238

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The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of adult CNS cancers ranging from noninvasive and surgically curable pilocytic astrocytomas to metastatic brain disease. The involvement of an interdisciplinary team, including neurosurgeons, radiation therapists, oncologists, neurologists, and neuroradiologists, is a key factor in the appropriate management of CNS cancers. Integrated histopathologic and molecular characterization of brain tumors such as gliomas should be standard practice. This article describes NCCN Guidelines recommendations for WHO grade I, II, III, and IV gliomas. Treatment of brain metastases, the most common intracranial tumors in adults, is also described.

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Section: Surgerymentioning

confidence: 99%

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Nabors

Portnow

Ahluwalia

et al. 2020

Journal of the National Comprehensive Cancer Network

350

238

View full text Add to dashboard Cite

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“…Thus an additional surgery can in uence the course of the disease [28] as well as a complicated wound healing [3]. Radiosurgery and whole brain therapy are possible alternatives to surgery [29,30].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Apparent Diffusion Coefficient Maps for the Differentiation of Brain Metastases from Lung cancer

Müller¹,

Khadhraoui²,

Neef³

et al. 2020

Preprint

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Background: Brain metastases are particularly common in patients with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), with NSCLC showing a more aggressive clinical course and lower chemo- and radio sensitivity compared to SCLC. Early adequate therapy is highly desirable and depends on a reliable classification of tumor type. The apparent diffusion coefficient is a noninvasive neuroimaging marker with the potential to differentiate between major histological subtypes. Here we determine the sensitivity and specificity of the apparent diffusion coefficient to distinguish between NSCLC and SCLC.Methods: We enrolled all NSCLC and SCLC patients diagnosed between 2008 and 2019 at the University Medical Center Göttingen. Cranial MR scans were visually inspected for brain metastases and the ratio of the apparent diffusion coefficient (ADC) was calculated by dividing the ADC measured within the solid part of a metastasis by a reference ADC extracted from an equivalent region in unaffected tissue on the contralateral hemisphere.Results: Out of 411 enrolled patients, we detected 129 patients (83 NSCLC, 46 SCLC) with sufficiently large brain metastases with histologically classified lung cancer and no hemorrhage. We analyzed 185 brain metastases, 84 of SCLC and 101 of NSCLC. SCLC brain metastases showed an ADC ratio of 0.68 ± 0.12 SD, and NSCLC brain metastases showed an ADC ratio of 1.47 ± 0.31 SD. Receiver operating curve statistics differentiated brain metastases of NSCLC from SCLC with an area under the curve of 0.99 and a 95% CI of 0.98 to 1, p < 0.001. Youden's J cut-point is 0.97 at a sensitivity of 0.989 and a specificity of 0.988. Conclusions: In patients with lung cancer and brain metastases with solid tumor parts, ADC ratio enables an ad hoc differentiation of SCLC and NSCLC, easily achieved during routine neuroradiological examination. Non-invasive MR imaging enables an early-individualized management of brain metastases from lung cancer.Trial registration: The study was registered in the German Clinical Trials Register (DRKS00023016).

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“…This #RadOnc #JC occurred on Twitter™ from Saturday, June 21st 8AM to Sunday, June 22nd 4PM Central Standard Time (CST) in accordance with our usual protocol. The online journal club included limited-time open-access of the publication [14] and an asynchronous online discussion followed by a live-hour to reduce barriers to participation, targeted online invitations to encourage diverse perspectives across disciplines and regions, moderation by a resident (IP) and diverse faculty (MK, RS, HS), and attendance by the study’s lead author (CR). Structured discussion topics (T1, T2, T3…) included an introduction for more general audiences then critical appraisal of the cohort study for application locally and globally by patients and providers.…”

Section: Methodsologymentioning

confidence: 99%

Stereotactic radiosurgery (SRS) – A new normal for small cell lung cancer?

Pereira

Slotman²,

Rusthoven

et al. 2020

Clinical and Translational Radiation Oncology

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Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases

Cited by 152 publications

References 39 publications

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Diagnostic Value of Apparent Diffusion Coefficient Maps for the Differentiation of Brain Metastases from Lung cancer

Stereotactic radiosurgery (SRS) – A new normal for small cell lung cancer?

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