Radiotherapy of brain metastases from small-cell lung cancer: standards and controversies

Kępka, Lucyna

doi:10.20517/2394-4722.2018.114

Cited by 6 publications

(11 citation statements)

References 52 publications

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“…For SCLC patients with known chemosensitivity, CHTresponse rates are even higher than in NSCLC: up to 66-73% (46,47). In SCLC patients with asymptomatic BM diagnosed at the initial staging, treatment usually starts with CHT, also with the intention of stopping life-threatening extracranial systemic and local disease progression (48). Taking into account the neurocognitive toxicity of WBRT which is most pronounced in the older adults, CHT alone may be a reasonable strategy for the SCLC patients with asymptomatic BM, especially considering that no survival benefit of adding WBRT to CHT was found in 1,615 patients >75 years with BM from SCLC (median OS was 5.6 months with WBRT and 6.4 months without, P=0.43) (49).…”

Section: Chemotherapymentioning

confidence: 99%

“…In patients with symptomatic BM occurring during firstline CHT without prior use of PCI, WBRT is usually given, then CHT may be continued or not depending on the systemic CHT response and performance status of the patient (48). In such a scenario, elderly patients receiving CHT should also be managed this way.…”

Section: Treatment Of Bm With Respect To Prophylactic Cranial Irradiation (Pci)mentioning

confidence: 99%

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Management of brain metastases in elderly patients with lung cancer

Socha¹,

Rychter²,

Kępka³

2021

J Thorac Dis

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The incidence of brain metastases (BM) is continuing to grow in the elderly population with lung cancer, but these patients are seriously under-represented in clinical trials. Thus, their treatment is not based on the evidence from randomized prospective studies. Age is a well recognized poor prognostic factor for survival in patients with BM from lung cancer, which is reflected in prognostic scales, but its impact on the patients' prognosis reflected by its value in gradually updated grading indices seems to decrease. The reason for poorer outcomes in the elderly is unknown-it may result from the influence of the age per se, simplified staging work-up and suboptimal treatment in this patient subgroup or the excess toxicity of the aggressive anticancer treatment secondary to the impaired physiological regulation mechanisms and comorbidities. The main goal of treatment of BM is to ameliorate neurological symptoms and delay neurological progression, with the focus on the improvement and maintenance of the patients' quality of life. The possible treatment options for BM from lung cancer are whole-brain radiotherapy, stereotactic radiosurgery, surgery, chemotherapy, targeted therapies and best supportive care. The aim of this review is to summarize the problems related to the management of BM in elderly patients with lung cancer, to analyze the value of the above mentioned treatment options, and to provide an insight into the influence of age-related clinical factors on the patients' outcomes.

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Section: Chemotherapymentioning

confidence: 99%

Section: Treatment Of Bm With Respect To Prophylactic Cranial Irradiation (Pci)mentioning

confidence: 99%

Management of brain metastases in elderly patients with lung cancer

Socha¹,

Rychter²,

Kępka³

2021

J Thorac Dis

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“…Berdasarkan perhitungan sampel 2 kelompok, dengan asumsi interval kepercayaan 95%, kekuatan 80%, metastasis otak pada KPKSK 40% dan pada KPKBSK 20%, maka diperlukan masing-masing 79 sampel untuk masing-masing tipe histopatologi. 10,11 Variabel yang diinvestigasi dalam penelitian ini adalah data demografi, klinis, dan gambaran imaging.…”

Section: Metodeunclassified

“…Subjek juga dilakukan penilaian indeks massa tubuh (IMT) dengan kriteria: underweight (IMT <18,5), normal ( IMT 18,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]9), dan overweight (IMT >23). Klasifikasi metastasis SSP dibagi menjadi metastasis otak, metastasis leptomeningeal, metastasis spinal, dan metastasis SSP multipel (gabungan 2 atau lebih metastasis otak, leptomeningeal, atau spinal).…”

Section: Metodeunclassified

Karakteristik Metastasis Sistem Saraf Pusat Dari Kanker Paru

Yosephine¹,

Aninditha

Sofyan

et al. 2020

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Pendahuluan: Sebanyak 40% pasien dengan kanker paru akan mengalami metastasis sistem saraf pusat (SSP) dalam perjalanan penyakitnya. Dari 40% tersebut, sebanyak 3-9% akan mengalami metastasis leptomeningeal, namun profil klinis keterlibatan SSP pada kanker paru belum pernah diteliti di Indonesia. Tujuan: Mengetahui gambaran metastasis SSP kanker paru di RSUPN Dr. Cipto Mangunkusumo (RSCM) dan RS Kanker Dharmais (RSKD). Metode: Penelitian potong lintang terhadap pasien kanker paru yang dikonsulkan ke bagian Neurologi di RSCM dan RSKD sepanjang tahun 2018. Kriteria inklusi adalah pasien dewasa yang sudah terdiagnosis sebagai kanker paru berdasarkan pemeriksaan histopatologi dan memiliki data rekam medis lengkap, hingga gambaran CT scan atau MRI kepala dengan kontras. Hasil: Didapatkan 48 subjek dengan median 57 (36-76) tahun, proporsi laki-laki lebih banyak dari pada perempuan (56,2% vs 44,8%) dan 31,3% mempunyai riwayat merokok. Jenis tumor paru tersering adalah kanker paru karsinoma bukan sel kecil (KPKBSK) atau non-small cell lung carcinoma (SCLC) (93,8%). Gejala neurologis terutama defisit motorik (62,5%), nyeri kepala (43,8%), gangguan fungsi luhur (20,8%), dan kejang (18,8%). Mayoritas subjek mengalami metastasis di otak (93,8%) dan sebanyak 8,3% di leptomeningeal. Diskusi: Didapatkan tumor otak akibat metastasis dari kanker paru dengan jenis KPKBSK (93,8%) dengan gejala neurologis utama defisit motorik (62,5%) dan nyeri kepala (43,8%). Kata kunci: Kankerparu, karsinoma sel kecil, metastasis otak.

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“…Small cell lung cancer (SCLC) is an aggressive form of lung cancer, making up approximately 13% of all newly diagnosed lung cancers [ 1 ]. In particular, SCLC is characterized by its propensity to metastasize to the brain in approximately 40%-50% of patients throughout the course of the disease [ 2 ]. When SCLC patients develop brain metastasis, the standard-of-care treatment is whole-brain radiotherapy (WBRT) [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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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Radiotherapy of brain metastases from small-cell lung cancer: standards and controversies

Abstract: How to cite this article: Kepka L. Radiotherapy of brain metastases from small-cell lung cancer: standards and controversies.

Cited by 6 publications

References 52 publications

Management of brain metastases in elderly patients with lung cancer

Management of brain metastases in elderly patients with lung cancer

Karakteristik Metastasis Sistem Saraf Pusat Dari Kanker Paru

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

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