Whole brain radiation therapy plus focal boost may be a suitable strategy for brain metastases in SCLC patients: a multi-center study

Abstract

Background: The treatment for brain metastases in small cell lung cancer (SCLC) is still controversial. The purpose of this study was to compare different brain radiotherapy treatments on SCLC patients with brain metastases. Methods: In this multi-center retrospective study, SCLC patients who had undergone whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) for brain metastases from January 2012 to December 2018 were retrospectively screened. Results: A total of 263 eligible SCLC patients were included in this study, among whom, 73 were women and 190 were men. According to accepted brain radiotherapy, the remaining patients were divided into WBRT plus focal radiation boost (WBRT+boost), WBRT, and SRS groups. In pairwise comparisons of the overall survival (OS), WBRT+boost group led to longer survival than did WBRT both in all patients (17.9 vs 8.7 months; P < 0.001) and 140 matched patients (17.9 vs 11.7 months; P = 0.045). There were no significant differences in OS between WBRT+boost and SRS groups in all patients (17.9 vs 14.5 months; P = 0.432). Among 74 matched patients between WBRT+boost and SRS groups, however, patients who received WBRT+boost led to a longer survival than did SRS alone (21.8 vs 12.9 months; P = 0.040). In pairwise comparison of the intracranial progression-free survival time (iPFS), WBRT+boost group also showed survival advantages over WBRT (10.8 vs 6.5 months; P = 0.005) and SRS groups (10.8 vs 7.5 months; P = 0.032). Conclusion: Due to the SCLC-derived multiple brain metastases and better survival time, focal radiation boost combined with adjuvant WBRT may be a preferred strategy for SCLC patients with brain metastases.

Optimizing Whole Brain Radiotherapy Treatment and Dose for Patients With Brain Metastases From Small Cell Lung Cancer

“…We also analyzed potential prognostic factors affecting OS and iPFS in SCLC patients receiving brain radiotherapy for BM. As previously reported, several prognostic factors have been identified, including age, KPS, extracranial metastases status, number of BMs, the maximum diameter of BM, and symptoms of BM (12,13). Our study revealed that the number of BMs and treatment were independent prognostic factors for OS, while it was treatment for iPFS.…”

“…Another study analyzed 263 SCLC BM patients, and they found that WBRT + boost resulted in longer OS than WBRT (17.9 vs . 8.7 months, p < 0.001) ( 13 ). Our findings were consistent with the previous studies.…”

“…Sun et al analyzed 82 patients with SCLC BM, and WBRT + boost significantly improved OS than WBRT alone (n = 49) (13.4 vs. 9.6 months, p = 0.004) (12). Another study analyzed 263 SCLC BM patients, and they found that WBRT + boost resulted in longer OS than WBRT (17.9 vs. 8.7 months, p < 0.001) (13). Our findings were consistent with the previous studies.…”

“…Previous randomized clinical trials have suggested that WBRT combined with SRS could reduce intracranial recurrence rate (10). For patients with poor performance status, some retrospective studies have demonstrated that whole brain radiotherapy plus local radiation boost (WBRT + boost) could improve the intracranial control and prolong the survival time (11)(12)(13). Several retrospective studies suggested that high biologically effective dose (BED) for brain radiotherapy could improve survival among SCLC patients with BM (14,15).…”

International consensus on severe lung cancer—the first edition

“…SCLC has a high propensity to metastasize into the brain due to certain biological features, and therefore WBRT is recommended for SCLC patients. For those with oligometastases, SRS used as boost irradiation on the basis of WBRT can be considered to improve local control rate (133,134). In addition, brain necrosis and edema after radiotherapy for brain metastases, especially SRS, are also clinical issues.…”