Because small cell lung cancer patients were excluded from the landmark prospective trials evaluating SRS, understanding of SRS for small cell lung cancer has lagged behind other cancers, including non-small cell lung cancer.
"Small cell lung cancer is known to have an increased propensity for spread to the brain compared to many other cancers. Historical caution regarding first-line SRS for small cell lung cancer has generally been related to concerns that omission of WBRT could result in rapid disease progression and decreased survival times. Thus, it is an important observation that, in this large international study, the omission of WBRT in favor of first-line SRS did not result in diminished overall survival," Rusthoven says.
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This analysis, which may represent the strongest data reported thus far in support of first-line SRS for small cell lung cancer, comes at a dynamic time in the evolution of small cell lung cancer management.
"Paradigms for the treatment of small cell lung cancer are evolving. In recent years, we have seen the integration of immunotherapy into small cell lung cancer management, a decrease in the administration of WBRT, and national guideline updates recommending routine brain MRI surveillance for all patients. These changes may be expected to increase the identification of small cell lung cancer patients with limited brain metastases who may be candidates for first-line SRS," Robin says.
The study also provided detailed analyses of outcomes with SRS by the number of brain lesions treated. Patients treated with SRS for a single brain metastasis experienced the best brain control and overall survival outcomes. After that, the clinical outcomes for patients with 2-4 vs 5-10 brain metastases where very similar, whereas patients with 11 or more metastases were seen to have the shortest time to brain progression and overall survival.
The authors note that prospective trials evaluating the role of first line SRS for small cell lung cancer patients are needed to confirm the encouraging results observed in this retrospective study. In the meantime, this large international analysis provides important descriptive and comparative data on first-line SRS as a potential emerging treatment option for brain metastases in carefully selected small cell lung cancer patients.
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