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

Abstract

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.

The efficacy of adebrelimab compared with durvalumab and atezolizumab in untreated extensive-stage small-cell lung cancer: a survival analysis of reconstructed patient-level data

“…There is a long way to prolong the PFS and OS. During the maintenance phase, the addition of radiotherapy to anti-PD-L1 therapy could effectively treat the primary lung or distant metastatic lesions (16,17). Moreover, antiangiogenic agents have been reported to enhance the effects of immunotherapy in ES-SCLC patients (12,18).…”