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

Viani, Gustavo Arruda; Gouveia, Andre G; Louie, Alexander V.; Moraes, Fábio Ynoe de

doi:10.1016/j.radonc.2021.06.026

Cited by 19 publications

(14 citation statements)

References 30 publications

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“…However, brain as a special site of progression, the choice of local therapy or systemic therapy as the primary treatment has not been determined [21][22][23][24][25][26]. Whole brain radiation therapy (WBRT) is now the standard treatment in many guidelines [1,10].…”

Section: Discussionmentioning

confidence: 99%

“…Whole brain radiation therapy (WBRT) is now the standard treatment in many guidelines [1,10]. For the patients with limited number of BMs, additional radiation boost to WBRT or stereotactic radiation therapy (SRT) can be recommended [21,23,25]. Several studies suggested that the occurrence of brain metastasis was a sign of systemic failure of tumor control, the treatment of brain metastasis should focus on chemoradiotherapy [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

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The prognostic effect of chemosensitivity on brain metastases in small-cell lung cancer: A retrospective analysis

Meng

Tian

et al. 2022

Preprint

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Purpose: To investigate the prognostic differences between small-cell lung cancer (SCLC) patients with different chemosensitivity to first line chemotherapy who developed brain metastasis as first site of progression. Methods: Patients with brain metastases (BMs) after first-line treatment of SCLC in our hospital admitted from January 2012 to October 2020 were retrospectively analyzed. According to the time interval between the completion of first-line chemotherapy and the onset of BMs (TFI), the patients were divided into chemo-sensitive group (TFI ≥ 90 days, n = 145) and chemo-resistant group (TFI ＜ 90 days, n = 97). Survival time after the onset of brain metastasis (BM-OS), which was calculated from the diagnosis of brain metastases and overall survival (OS), which was calculated from the diagnosis of small-cell lung cancer, were analyzed in this study. Survival curves were plotted using Kaplan-Meier method and differences between groups were compared using the log-rank test. The Chi-square test or Fisher’s exact test was used to compare categorical variables. Results: In total, the median BM-OS and OS were 8.4 months and 18.2 months respectively. The median BM-OS in chemo-sensitive group was 8.8 months and it was 8.0 months in the chemo-resistant group (P = 0.538); and the median OS was 22.0 months and 15.6 months, respectively (P = 0.001). In patients without extracranial progression (n = 193), the median BM-OS in chemo-sensitive and chemo-resistant group were 9.4 months and 9.7 months (P = 0.947), and the median OS were 22.7 months and 16.3 months, respectively (P = 0.017). In patients with extracranial progression (n = 49), the median BM-OS were 5.4 months and 4.2 months (P = 0.161), and the median OS were 17.6 months and 12.3 months, respectively (P = 0.002). Conclusions: After the development of brain metastasis as the first site of progression following chemotherapy in small cell lung cancer, the prognosis of chemo-sensitive patients not necessarily superior to chemo-resistant patients, especially in patients without extracranial progression.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The prognostic effect of chemosensitivity on brain metastases in small-cell lung cancer: A retrospective analysis

Meng

Tian

et al. 2022

Preprint

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“…This risk theoretically increases with the number of metastases, as it might represent a surrogate for the overall extent of intracranial disease, both macroscopic and microscopic. However, recent literature in support of SRS compared to WBRT calls into question whether this potential for increased intracranial control is worth the added toxicity if a patient can be closely monitored with serial MRI and undergo additional salvage radiation if needed [ 10 , 11 ]. However, the use of SRS for more than 15 lesions, particularly with SCLC histology, rightly remains highly controversial.…”

Section: Discussionmentioning

confidence: 99%

“…While, as expected, intracranial control was inferior in patients treated with SRS, overall survival (OS) was actually improved in patients receiving SRS. In subsequent meta-analyses by Gaebe et al [ 10 ] and Viani et al [ 11 ], these results were replicated, with SRS being associated with an improvement in OS, thereby establishing SRS as a viable treatment option. Importantly, these studies are limited by the inclusion of retrospective studies and associated selection bias but still support consideration of SRS in future studies.…”

Section: Introductionmentioning

confidence: 89%

Stereotactic Radiosurgery in a Small Cell Lung Cancer Patient With Numerous Brain Metastases

Lian¹,

Ladbury²,

Amini³

2022

Cureus

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Small cell lung cancer (SCLC) is an aggressive form of lung cancer characterized by its propensity to metastasize to the brain. When SCLC patients develop brain metastasis, the standard-of-care treatment is whole-brain radiotherapy (WBRT), with the goal of treating both macroscopic and microscopic tumors. However, WBRT is found to be associated with significant morbidity including cognitive impairment. An emerging alternative to WBRT for SCLC is stereotactic radiosurgery (SRS), supported by a recent multi-institutional series and meta-analysis. However, there is limited evidence on the use of SRS when there are greater than 15 lesions from any histology, much less SCLC, where the risk of microscopic disease is felt to be even higher. Here, we present the case of an adult female with extensive-stage SCLC who developed 23 brain metastases. Due to patient preference, these were treated with SRS to a total dose of 20 Gy in one fraction. The patient did not experience any radiation-induced toxicity, including radionecrosis, and had overall favorable intracranial control using SRS alone at the time of her death, which was due to extracranial disease progression. This case adds to the literature suggesting that SRS could be a reasonable option for patients with SCLC. It illustrates that it might be reasonable to seek to expand on who might be considered a candidate for SRS treatment, with a high number of lesions not necessarily representing imminent widespread intracranial disease progression.

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“…Approximately 10–25% of patients with SCLC have symptomatic or asymptomatic brain metastases at initial diagnosis, and more than 50% will develop brain metastases during the disease course ( 2 ). Radiotherapy is commonly used for the treatment of brain metastases from SCLC, with a local control rate up to 93% ( 3 ). However, the survival was still dismal, with a 12-month overall survival (OS) rate of 39% ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Intracranial complete response to toripalimab and anlotinib in a patient with recurrent brain metastases of small cell lung cancer after failure of second-line maintenance therapy: a case report

Huang¹,

Tang²,

Lou³

et al. 2022

Transl Cancer Res TCR

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Background: Approximately 10-25% of patients with small cell lung cancer (SCLC) have brain metastases at the time of diagnosis. Radiotherapy is a common treatment for brain metastases, but the relapse rates are high. Accumulating evidence suggests that immunotherapy may have a better therapeutic effect for brain metastases. Here, we reported a patient with limited-stage SCLC and relapsed brain metastases who achieved sustained intracranial complete response (CR) to programmed cell death-1 (PD-1) inhibitor toripalimab and multikinase inhibitor anlotinib.Case Description: A 59-year-old female patient developed brain metastases after initial treatment for limited stage SCLC. CR of brain lesions was achieved after intensity-modulated radiation therapy followed by chemotherapy with irinotecan plus lobaplatin and concurrent anlotinib. PD-1 inhibitor sintilimab combined with anlotinib were given as maintenance therapy. Small and asymptomatic brain lesions relapsed 2.5 months after achieving CR. Another three cycles of sintilimab combined with anlotinib failed to control the relapsed brain lesions. Following two cycles of another PD-1 inhibitor toripalimab combined with anlotinib, the relapsed brain metastases disappeared. Then the patient received another seven cycles of this regimen with sustained CR, and no serious adverse reactions occurred. Interestingly, the primary lung tumor achieved sustained CR from the end of initial treatment to the last follow-up.Conclusions: This case suggests that toripalimab in combination with anlotinib may be a promising treatment option for patients with brain metastases from SCLC.

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

Cited by 19 publications

References 30 publications

The prognostic effect of chemosensitivity on brain metastases in small-cell lung cancer: A retrospective analysis

The prognostic effect of chemosensitivity on brain metastases in small-cell lung cancer: A retrospective analysis

Stereotactic Radiosurgery in a Small Cell Lung Cancer Patient With Numerous Brain Metastases

Intracranial complete response to toripalimab and anlotinib in a patient with recurrent brain metastases of small cell lung cancer after failure of second-line maintenance therapy: a case report

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