Stereotactic radiosurgery for patients with brain metastases from small cell lung cancer

Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):e21-7. doi: 10.1016/j.ijrobp.2011.01.001. Epub 2011 Feb 23.


Background: Patients with small-cell lung cancer have a high likelihood of developing brain metastases. Many of these patients will have prophylactic cranial irradiation (PCI) or eventually undergo whole brain radiation therapy (WBRT). Despite these treatments, a large number of these patients will have progression of their intracranial disease and require additional local therapy. Stereotactic radiosurgery (SRS) is an important treatment option for such patients.

Methods: We retrospectively reviewed the charts of 44 patients with brain metastases from small-cell lung cancer treated with gamma knife SRS. Multivariate analysis was used to determine significant prognostic factors influencing survival.

Results: The median follow-up from SRS in this patient population was 9 months (1-49 months). The median overall survival (OS) was 9 months after SRS. Karnofsky performance status (KPS) and combined treatment involving WBRT and SRS within 4 weeks were the two factors identified as being significant predictors of increased OS (p = 0.033 and 0.040, respectively). When comparing all patients, patients treated with a combined approach had a median OS of 14 months compared to 6 months if SRS was delivered alone. We also compared the OS times from the first definitive radiation: WBRT, WBRT and SRS if combined therapy was used, and SRS if the patient never received WBRT. The median survival for those groups was 12, 14, and 13 months, respectively, p = 0.19. Seventy percent of patients had follow-up magnetic resonance imaging available for review. Actuarial local control at 6 months and 12 months was 90% and 86%, respectively. Only 1 patient (2.2%) had symptomatic intracranial swelling related to treatment, which responded to a short course of steroids. New brain metastases outside of the treated area developed in 61% of patients at a median time of 7 months; 81% of these patients had received previous WBRT.

Conclusions: Stereotactic radiosurgery for small-cell lung carcinoma brain metastases provided safe and effective local tumor control in the majority of patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Neoplasms / mortality
  • Brain Neoplasms / radiotherapy
  • Brain Neoplasms / secondary
  • Brain Neoplasms / surgery*
  • Cranial Irradiation / methods
  • Female
  • Humans
  • Karnofsky Performance Status
  • Lung Neoplasms* / mortality
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Radiosurgery / methods*
  • Retrospective Studies
  • Small Cell Lung Carcinoma / mortality
  • Small Cell Lung Carcinoma / radiotherapy
  • Small Cell Lung Carcinoma / secondary
  • Small Cell Lung Carcinoma / surgery*
  • Survival Analysis