Stereotactic Radiosurgery vs Whole Brain Radiotherapy in Patients With SCLC and Intracranial Metastatic Disease

Treatment with stereotactic radiosurgery was associated with equitable survival outcomes vs whole brain radiotherapy in patients with small-cell lung cancer (SCLC) and intracranial metastatic disease (IMD), according to findings from a systematic review and meta-analysis.

“To our knowledge, this is the first systematic review and meta-analysis evaluating survival and intracranial response outcomes in patients with SCLC and brain metastases treated with [stereotactic radiosurgery],” explained Karolina Gaebe, MD, University of Toronto, Ontario, Canada, and colleagues.

Data was derived from MEDLINE, Embase, CENTRAL, and grey literature sources for controlled trials and cohort studies published in English reporting on stereotactic radiosurgery for IMD treatment in patients with SCLC. Of the 31 identified records eligible for inclusion, 7 were included in the meta-analysis.

The primary outcome of the study was overall survival (OS). Random-effects meta-analysis pooled hazard ratios (HRs) for studies comparing stereotactic radiosurgery with whole brain radiotherapy with or without stereotactic radiosurgery boost. OS was pooled as medians for single-arm studies on stereotactic radiosurgery.

Stereotactic radiosurgery yielded longer OS than whole brain radiotherapy with or without stereotactic radiosurgery boost (hazard ratio [HR], 0.85; 95% confidence interval [CI] 0.75 to 0.97; n = 7 studies; n = 18,130 patients), or whole brain radiotherapy alone (HR, 0.77; 95% CI, 0.72 to 0.83; n = 7 studies; n = 16,961 patients), but not vs whole brain radiotherapy plus stereotactic radiosurgery boost (HR, 1.17; 95% CI, 0.78 to 1.75; n = 4 studies; n = 1167 patients). Single-arm studies found pooled median overall survival from stereotactic radiosurgery was 8.99 months (95% CI, 7.86 to 10.16; n = 14 studies; n = 1682 patients). Pooled comparative studies produced considerable between-study heterogeneity (I² = 71.9%).

“Our findings suggest that [stereotactic radiosurgery] can achieve equitable survival compared with [ whole-brain radiotherapy] in patients with SCLC, challenging previous reservations regarding the use of [stereotactic radiosurgery] in these patients given the perceived risk of rapid intracranial progression,” wrote Gaebe and colleagues.

The authors noted the study is not without limitations, including limited data availability, underreporting of several key outcomes that inform the comparison of stereotactic radiosurgery to [ whole brain radiotherapy], and the exclusion of articles published in languages other than English.

“Future prospective studies should focus on tumour burden and differences in local and distant intracranial progression between [ whole brain radiotherapy]-treated and [stereotactic radiosurgery]-treated patients with SCLC,” concluded Gaebe et al.

Source:                                        

Gaebe K, Li AY, Park A, et al. Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis. Lancet Oncol. May 2022. doi:10.1016/S1470-2045(22)00271-6