Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States.
Lung Cancer. 2018 Jun;120:88-90. doi: 10.1016/j.lungcan.2018.03.027. Epub 2018 Apr 2.
Whole-brain radiation therapy (WBRT) is the standard approach for brain metastases (BM) arising in patients with small-cell lung cancer (SCLC), but the neurocognitive toxicities of WBRT are well documented. For this reason, stereotactic radiosurgery (SRS) alone is the preferred modality for limited BM in most histologies, but in SCLC there are few data exploring this approach.
We queried the National Cancer Database (NCDB) for patients with SCLC with BM at diagnosis and stratified by upfront SRS compared with upfront WBRT ± SRS. We utilized multivariate Cox regression and propensity score matching (PSM) to determine the impact on overall survival (OS) of each approach.
5952 eligible patients (WBRT: 5752; SRS: 200) were identified from 2010 to 2014 with a median follow-up of 40.0 months. Upfront SRS was associated with superior OS (median 10.8 vs 7.1 months, HR 0.65, 95% CI 0.55-0.75, p < 0.001), which persisted on multivariate analysis controlling for comorbidities, extracranial metastases, age, race/ethnicity, and gender (HR 0.70, 95% CI 0.60-0.81, p < 0.001). These results were confirmed in PSM analysis. A subset analysis comparing outcomes after SRS vs SRS + WBRT showed no differences in OS (p = .601).
To our knowledge, this is the largest dataset of patients treated with SRS alone for SCLC. The observation of favorable OS with SRS alone in this contemporary dataset suggests that SRS alone may be appropriate for some patients with SCLC. Prospective investigations of SRS in SCLC are warranted.
全脑放疗（WBRT）是治疗小细胞肺癌（SCLC）患者脑转移（BM）的标准方法，但 WBRT 的神经认知毒性已有充分记录。出于这个原因，立体定向放射外科手术（SRS）是大多数组织学中有限 BM 的首选方法，但在 SCLC 中，很少有数据探索这种方法。
我们从 2010 年至 2014 年的国家癌症数据库（NCDB）中查询了诊断时有 BM 的 SCLC 患者，并按初始 SRS 与初始 WBRT ± SRS 进行分层。我们利用多变量 Cox 回归和倾向评分匹配（PSM）来确定每种方法对总生存期（OS）的影响。
2010 年至 2014 年期间，从 NCDB 中确定了 5952 名符合条件的患者（WBRT：5752 例；SRS：200 例），中位随访时间为 40.0 个月。初始 SRS 与较好的 OS 相关（中位 10.8 个月比 7.1 个月，HR 0.65，95%CI 0.55-0.75，p<0.001），在多变量分析中控制合并症、颅外转移、年龄、种族/族裔和性别后仍然存在（HR 0.70，95%CI 0.60-0.81，p<0.001）。PSM 分析证实了这些结果。比较 SRS 与 SRS+WBRT 后结果的亚组分析显示，OS 无差异（p=0.601）。
据我们所知，这是最大的一组单独用 SRS 治疗 SCLC 的患者数据集。在这个当代数据集，单独使用 SRS 观察到的有利 OS 表明，单独使用 SRS 可能适合某些 SCLC 患者。需要对 SRS 在 SCLC 中的应用进行前瞻性研究。
