Journal Article

Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF)

Maiti, Tonmoy, Tien, Christopher J, Lunsford, L Dade, Grills, Inga S, Liscak, Roman, Warnick, Ronald E, Yang, Huai-che, Fang, Wei, Borghei-Razavi, Hamid, Chiang, Veronica, Barnett, Gene H, Guseynova, Khumar, Mathieu, David, Siddiqui, Zaid A, Cifarelli, Christopher P, Yuan, Justin C, Sheehan, Jason P, Faramand, Andrew, Cordeiro, Diogo, Lee, Cheng-chia, Hess, Judith, Kano, Hideyuki, Vargo, John A, Touchette, Charles J

2020

Overview

Abstract BACKGROUND Despite a high incidence of brain metastases in patients with small-cell lung cancer (SCLC), limited data exist on the use of stereotactic radiosurgery (SRS), specifically Gamma Knife™ radiosurgery (Elekta AB), for SCLC brain metastases. OBJECTIVE To provide a detailed analysis of SCLC patients treated with SRS, focusing on local failure, distant brain failure, and overall survival (OS). METHODS A multi-institutional retrospective review was performed on 293 patients undergoing SRS for SCLC brain metastases at 10 medical centers from 1991 to 2017. Data collection was performed according to individual institutional review boards, and analyses were performed using binary logistic regression, Cox-proportional hazard models, Kaplan-Meier survival analysis, and competing risks analysis. RESULTS Two hundred thirty-two (79%) patients received SRS as salvage following prior whole-brain irradiation (WBRT) or prophylactic cranial irradiation, with a median marginal dose of 18 Gy. At median follow-up after SRS of 6.4 and 18.0 mo for surviving patients, the 1-yr local failure, distant brain failure, and OS were 31%, 49%, and 28%. The interval between WBRT and SRS was predictive of improved OS for patients receiving SRS more than 1 yr after initial treatment (21%, <1 yr vs 36%, >1 yr, P = .01). On multivariate analysis, older age was the only significant predictor for OS (hazard ratio 1.63, 95% CI 1.16-2.29, P = .005). CONCLUSION SRS plays an important role in the management of brain metastases from SCLC, especially in salvage therapy following WBRT. Ongoing prospective trials will better assess the value of radiosurgery in the primary management of SCLC brain metastases and potentially challenge the standard application of WBRT in SCLC patients. Graphical Abstract Graphical Abstract

• Publisher: Oxford University Press,Copyright by the Congress of Neurological Surgeons,Wolters Kluwer Health, Inc
• Subject: Aged / Brain cancer / Brain Neoplasms - secondary / Brain Neoplasms - surgery / Cancer / Cancer surgery / Care and treatment / Data entry / Editor's Choice / Female / Gamma rays / Humans / Kaplan-Meier Estimate / Lung cancer / Lung Neoplasms - pathology / Male / Medical centers / Metastasis / Middle Aged / Oncology, Experimental / Proportional Hazards Models / Prospective Studies / Radiation / Radiation therapy / Radiosurgery / Radiosurgery - methods / Radiosurgery - mortality / Research—Human—Clinical Studies / Retrospective Studies / Salvage Therapy - methods / Salvage Therapy - mortality / Small Cell Lung Carcinoma - mortality / Small Cell Lung Carcinoma - secondary / Small Cell Lung Carcinoma - surgery / Surgery / Survival analysis / Toxicity