Wang Victoria H, Juneja Badal, Goldman Howard Warren, Turtz Alan, Bilbao Chris, Xu Qianyi, Mulvihill Dave, Eastwick Gary, Kubicek Gregory J
Cooper Medical School of Rowan University, Camden, New Jersey.
Department of Radiation Oncology, MD Andersen Cancer Center at Cooper University Healthcare, Camden, New Jersey.
Adv Radiat Oncol. 2023 Apr 9;8(5):101237. doi: 10.1016/j.adro.2023.101237. eCollection 2023 Sep-Oct.
Treatment of small cell lung cancer (SCLC) with brain metastatic disease has traditionally involved whole brain radiation therapy (WBRT). The role of stereotactic radiosurgery (SRS) is unclear.
Our study was a retrospective review of an SRS database evaluating patients with SCLC who received SRS. A total of 70 patients and 337 treated brain metastases (BM) were analyzed. Forty-five patients had previous WBRT. The median number of treated BM was 4 (range, 1-29).
Median survival was 4.9 months (range, 0.70-23.9). The number of treated BM was correlated with survival; patients with fewer BM had improved overall survival ( < .021). The number of treated BM was associated with different brain failure rates; 1-year central nervous system control rates were 39.2% for 1 to 2 BM, 27.6% for 3 to 5 BM, and 0% for >5 treated BM. Patients with previous WBRT had worse brain failure rates ( < .040). For patients without previous WBRT, the 1-year distant brain failure rate was 48%, and median time to distant failure was 15.3 months.
SRS for SCLC in patients with <5 BM appears to offer acceptable control rates. Patients with >5 BM have high rates of subsequent brain failure and are not ideal candidates for SRS.
传统上，小细胞肺癌（SCLC）脑转移疾病的治疗涉及全脑放射治疗（WBRT）。立体定向放射外科（SRS）的作用尚不清楚。
我们的研究是对一个SRS数据库进行回顾性分析，该数据库评估了接受SRS治疗的SCLC患者。共分析了70例患者和337个接受治疗的脑转移瘤（BM）。45例患者曾接受过WBRT。治疗的BM中位数为4个（范围1 - 29个）。
中位生存期为4.9个月（范围0.70 - 23.9个月）。治疗的BM数量与生存期相关；BM数量较少的患者总生存期有所改善（P < 0.021）。治疗的BM数量与不同的脑衰竭率相关；1至2个BM的1年中枢神经系统控制率为39.2%，3至5个BM为27.6%，>5个接受治疗的BM为0%。曾接受WBRT的患者脑衰竭率更差（P < 0.040）。对于未接受过WBRT的患者，1年远处脑衰竭率为48%，远处衰竭的中位时间为15.3个月。
对于BM < 5个的SCLC患者，SRS似乎能提供可接受的控制率。BM > 5个的患者后续脑衰竭率高，不是SRS的理想候选者。
