Curative thoraco-systemic therapy plus local treatment to the brain for extensive disease-small-cell lung cancer with metastasis only to the brain

Abstract

We reviewed 11 cases of extensive disease (ED)-SCLC and metastasis only to the brain treated during 2011–14. All patients underwent definitive therapy similar to that for limited disease (LD), combined with local treatment for BM. We compared the survival outcomes of these patients to those of patients with LD (n = 29) or other ED (n = 38) during the same period. Three patients had progression of BM at completion of chemotherapy. Ten patients received whole-brain radiotherapy (4 prophylactic, 6 therapeutic), and remaining one elderly patient underwent stereotactic radiosurgery. Finally, 8 and 3 patients achieved a CR or PR of BM, respectively. Five remained free of progression for 21.1–73.2 months. The progression-free and overall survival outcomes of ED-SCLC with brain only metastases were comparable to those of LD and superior to those of other ED. In conclusion, ED-SCLC with metastasis limited to the brain could be treated with curative intent.

Association of Brain Metastases With Survival in Patients With Limited or Stable Extracranial Disease

“…The literature search identified 1067 unique studies, of which 68 studies met eligibility criteria (Figure 1; eTable 3 in Supplement 1). Among included studies, there were 58 retrospective cohort studies, 7 prospective cohort studies, and 3 RCTs. Thirty-four reported on non–small cell lung cancer (NSCLC), 3 on breast cancer, 2 on small-cell lung cancer, 1 on melanoma, and 1 reported multiple lung cancers.…”

“…Abbreviations: ECD, extracranial disease; IMD-PE, intracranial metastatic disease in the setting of progressive ECD; IMD-SE, intracranial metastatic disease in the setting of stable ECD; iPFS, intracranial progression-free survival; OS, overall survival; PFS, progression-free survival. a Data are from 49 studies b Data are from 4 studies …”

“…Twenty-seven studies reported median OS in patients with IMD-SE . Among these, the pooled median OS was 20.9 months; (95% CI, 16.35-25.98 months; n = 2159 patients) for all patients with IMD-SE (Figure 3A).…”

“…Among these, the pooled median OS was 20.9 months; (95% CI, 16.35-25.98 months; n = 2159 patients) for all patients with IMD-SE (Figure 3A). Of note, 9 studies did not report a median follow-up . In patients with IMD-SE secondary to breast cancer and NSCLC, pooled median OS were 20.2 months (95% CI, 10.4-38.2 months; n = 2 studies; n = 109 patients) (Figure 3B) and 27.5 months (95% CI, 18.3-49.7 months; n = 13 studies; n = 497 patients) (Figure 3C), respectively.…”

“…Of note, 9 studies did not report a median follow-up. 20,34,39,55,59,60,63,73,80 In patients with IMD-SE secondary to breast cancer 20,60 and NSCLC, 27,36,39,[41][42][43][44]59,63,66,73,81,85 3A). 32,49,60,67 Weighted median OS from any first-line treatment was 23.…”