Local Control Outcomes of Patients With Brain Metastases From Small Cell Lung Cancer Treated With Stereotactic...

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Medical Oncology

Background:

• Stereotactic radiosurgery (SRS) is increasingly utilized for brain metastases (BM) in small cell lung cancer (SCLC).
• SRS can be administered either following whole-brain radiation therapy (WBRT) or as an upfront treatment.
• Institutional outcomes for SCLC patients undergoing SRS for BM are reported.

Purpose of the Study:

• To evaluate the institutional outcomes of patients with SCLC treated with SRS for brain metastases.
• To assess the efficacy of SRS in terms of local control, freedom from distant brain failure, and overall survival.
• To identify factors associated with improved outcomes in SCLC patients with BM treated with SRS.

Main Methods:

• A retrospective analysis of 135 patients with 429 SCLC BM treated with single-fraction SRS between 2002 and 2025.
• Primary endpoint: local control (LC). Secondary endpoints: freedom from distant brain failure (FFDBF) and overall survival (OS).
• Analysis included evaluation of prescription dose, staged SRS, prior WBRT/prophylactic cranial irradiation (PCI), and concurrent systemic therapy.

Main Results:

• One-year LC, FFDBF, and OS were 89%, 21%, and 26%, respectively.
• For BM receiving ≥20 Gy, 30 Gy (staged), and <20 Gy, 1-year LC was 92%, 87%, and 68%, respectively.
• Prescription dose ≥20 Gy or staged SRS was associated with improved LC (P=0.01), while prior PCI/WBRT and concurrent systemic therapy were not significant factors.

Conclusions:

• SRS demonstrates high local control for SCLC BM, including post-PCI/WBRT recurrences.
• Overall survival is primarily limited by systemic progression.
• Consideration of prescription dose ≥20 Gy or staged SRS is recommended when feasible for SCLC BM.