Is whole-brain radiation still best for brain metastases from small-cell lung cancer?

April 16, 2018 by Garth Sundem, CU Anschutz Medical Campus
Chad Rusthoven, MD

Lung cancer often metastasizes to the brain. Historically, brain metastases have been treated with whole-brain radiation therapy. However, whole-brain radiation is associated with cognitive side-effects and studies of non-small cell lung cancer patients have shown that a more targeted form of radiation, known as stereotactic radiosurgery, can improve cognitive outcomes and is highly effective for treating limited numbers of brain metastases. However, these studies have usually excluded patients with the related but different form of the disease known as small-cell lung cancer and, for patients with this tumor type, whole-brain radiation remains the standard of care for limited and even solitary brain metastases.

A recent study from investigators at the University of Colorado Cancer Center challenges the use of whole- for all small-cell with brain metastases. The study, recently published in the journal Lung Cancer, compared the outcomes of 5,752 small-cell lung who received whole-brain radiation therapy (WBRT) with those of 200 patients who received (SRS), finding that the median overall survival was actually longer with SRS (10.8 months with SRS versus 7.1 months with WBRT).

"One of the historic reservations regarding the use of SRS in small-cell lung cancer has been the concern that, by omitting WBRT, a patient could be at a higher risk of a diffuse progression of brain metastases, and that this could negatively affect prognosis. This study begins to address that concern by showing encouraging survival outcomes with SRS alone," says Chad Rusthoven, MD, assistant professor in Radiation Oncology at the University of Colorado Cancer Center, the paper's senior author.

The study used the largest cancer registry in the U.S., the National Cancer Database (NCDB), and analyzed cases of patients with at time of diagnosis from 2010-2014. Because the standard of care was WBRT, the vast majority of patients were treated with this therapy. But a significant minority was treated with SRS, allowing the researchers to compare the outcomes of these two populations. Across age, gender, race, and health status, patients treated with SRS tended to have better overall survival than patients treated with WBRT.

"Even though we only identified 200 patients treated with SRS, to the best of our knowledge, it's the largest data set of patients treated this way and one of the first dedicated analyses of the approach in the U.S. The study offers preliminary evidence to support further research in to the role of SRS for patients with small-cell lung cancer," says the study's lead author, Dr. Tyler Robin.

The authors point out that the study is limited by the fact that it retrospectively looks back at historical outcomes of patients treated with SRS and WBRT, rather than randomizing patients to SRS and WBRT groups and then tracking their outcomes prospectively. This makes the current study subject to the influence of selection bias, for example, if SRS patients happened to be healthier than WBRT patients to begin with. As such, the authors do not suggest that the observations from this study will change the standard of care, but they think that the results will encourage further investigation into SRS for small-cell lung cancer.

"We hope that this analysis will encourage other investigators to ask questions about the potential role of SRS for carefully-selected patients with small-cell cancer," says Rusthoven, "and we believe that as therapies improve and patients live longer, strategies designed to limit the negative neurocognitive and quality-of-life effects of WBRT are likely to gain increasing importance."

Explore further: Radiosurgery or whole-brain radiation in patients with multiple brain metastases?

More information: Tyler P. Robin et al, Radiosurgery alone is associated with favorable outcomes for brain metastases from small-cell lung cancer, Lung Cancer (2018). DOI: 10.1016/j.lungcan.2018.03.027

Related Stories

Radiosurgery or whole-brain radiation in patients with multiple brain metastases?

December 18, 2017
Although targeted therapies have produced dramatic advances in our ability to control some types of advanced lung cancer, growth of the disease in the brain remains a major problem. Radiation is often used to treat deposits ...

Stereotactic radiosurgery may be best for patients with metastatic brain tumors

July 26, 2016
Patients with three or fewer metastatic brain tumors who received treatment with stereotactic radiosurgery (SRS) had less cognitive deterioration three months after treatment than patients who received SRS combined with whole ...

Risks of whole brain radiation therapy outweigh benefits for patients with limited brain metastases

June 1, 2015
Whole Brain Radiation Therapy (WBRT) is associated with significantly worse cognitive function than radiosurgery, and should no longer be used in the adjuvant setting after radiosurgery to treat cancer patients with brain ...

Study compares cognitive outcomes for treatments of brain lesions

July 26, 2016
Among patients with 1 to 3 brain metastases, the use of stereotactic radiosurgery (SRS) alone, compared with SRS combined with whole brain radiotherapy, resulted in less cognitive deterioration at 3 months, according to a ...

Improved survival for patients with brain mets who are 50 and younger and receive SRS alone

March 2, 2015
Cancer patients with limited brain metastases (one to four tumors) who are 50 years old and younger should receive stereotactic radiosurgery (SRS) without whole brain radiation therapy (WBRT), according to a study available ...

Research questions whole brain radiotherapy for older lung cancer patients

September 7, 2016
Older lung cancer patients whose disease has spread to the brain could be spared potentially harmful radiotherapy, new research indicates.

Recommended for you

Potential seen for tailoring treatment for acute myeloid leukemia

December 8, 2018
Advances in rapid screening of leukemia cells for drug susceptibility and resistance are bringing scientists closer to patient-tailored treatment for acute myeloid leukemia (AML).

Study may offer doctors a more effective way to treat neuroblastoma

December 7, 2018
A very large team of researchers, mostly from multiple institutions across Germany, has found what might be a better way to treat patients with neuroblastoma, a type of cancer. In their paper published in the journal Science, ...

Major breakthrough in quest for cancer vaccine

December 6, 2018
The idea of a cancer vaccine is something researchers have been working on for over 50 years, but until recently they were never able to prove exactly how such a vaccine would work.

'Chemo brain' caused by malfunction in three types of brain cells, study finds

December 6, 2018
More than half of cancer survivors suffer from cognitive impairment from chemotherapy that lingers for months or years after the cancer is gone. In a new study explaining the cellular mechanisms behind this condition, scientists ...

Scientists develop new technology for profiling unique genetic makeup of myeloma tumor cells

December 6, 2018
Cancer arises when cells lose control. Deciphering the "blueprint" of cancer cells—outlining how cancer cells hijack specific pathways for uncontrolled proliferation—will lead to more efficient ways to fight it. Joint ...

Putting the brakes on tumor stealth

December 6, 2018
New research undertaken at Monash University has shed new light on how some cancers are able to escape our immune system.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.