Original Article
Fractionated stereotactic radiotherapy for small-cell lung cancer patients with brain metastases ABSTRACT Objective: Patients with small‑cell lung cancer (SCLC) are at high risk of developing brain metastases (BM). Fractionated stereotactic radiotherapy (FSRT) alone or combined with whole brain radiation therapy can be used to treat intracranial metastases. This study was aimed to explore FSRT for BM from SCLC. Materials and Methods: We retrospectively analyzed 45 patients with BM from SCLC treated with fractionated linear accelerator FSRT. Multivariate analysis was used to determine independent risk factors of overall survival (OS). Results: There were 35 patients treated with salvage FSRT and 10 patients treated with primary FSRT. The median OS was 10 months from the beginning of FSRT and 19 months from diagnosis of BM. The median OS of salvage FSRT group and primary FSRT group was 22 and 10 months from the diagnosis of BM, respectively (P = 0.011); 11 and 8 months from FSRT, respectively (P = 0.828). Recursive partitioning analysis class and the stage of the primary tumor were independent predictors of increased OS (relative risk [RR] = 2.634, P = 0.021 and RR = 2.324, P = 0.0210, respectively). Conclusions: Salvage and primary FSRT were both effective treatment options for BM from SCLC. Salvage and primary FSRT may have different OS from the time of diagnosis of BM. KEY WORDS: Brain metastases, radiotherapy, salvage, small‑cell lung cancer, stereotactic radiotherapy
INTRODUCTION Lung cancer is the most common malignancies and the leading cause of brain metastases (BM) in the United States. An estimated 277,000 deaths resulted from small‑cell lung cancer (SCLC) were reported in 2008.[1,2] Patients with SCLC are at high risk of developing BM. Previous studies suggested that prophylactic cranial irradiation (PCI) may reduce or delay the onset of BM.[3,4] A large European randomized trial has demonstrated a possible benefit of PCI treatment regimen in patients who were responsive to chemotherapy.[5] Until date, there are no established standard treatment recommendations for BM from SCLC.[6] For most patients, whole brain radiation therapy (WBRT) is the primary treatment option in clinical practice. However, recurrent lesions were reported and the repeated WBRT will cause intolerable side‑effect.[7,8] Stereotactic surgery (SRS) or SRT can be used in this condition. Most of the previously published randomized controlled trials did not include patients with BM from SCLC.[9,10] Several retrospective studies reported that the local control (LC) rate was 70‑95% and median overall survival (OS) was 4.5‑9 months in patients with BM from SCLC.[11‑13]
SRS was generally used for the treatment of BM patients with tumor size
Fractionated stereotactic radiotherapy for small-cell lung cancer patients with brain metastases ABSTRACT Objective: Patients with small‑cell lung cancer (SCLC) are at high risk of developing brain metastases (BM). Fractionated stereotactic radiotherapy (FSRT) alone or combined with whole brain radiation therapy can be used to treat intracranial metastases. This study was aimed to explore FSRT for BM from SCLC. Materials and Methods: We retrospectively analyzed 45 patients with BM from SCLC treated with fractionated linear accelerator FSRT. Multivariate analysis was used to determine independent risk factors of overall survival (OS). Results: There were 35 patients treated with salvage FSRT and 10 patients treated with primary FSRT. The median OS was 10 months from the beginning of FSRT and 19 months from diagnosis of BM. The median OS of salvage FSRT group and primary FSRT group was 22 and 10 months from the diagnosis of BM, respectively (P = 0.011); 11 and 8 months from FSRT, respectively (P = 0.828). Recursive partitioning analysis class and the stage of the primary tumor were independent predictors of increased OS (relative risk [RR] = 2.634, P = 0.021 and RR = 2.324, P = 0.0210, respectively). Conclusions: Salvage and primary FSRT were both effective treatment options for BM from SCLC. Salvage and primary FSRT may have different OS from the time of diagnosis of BM. KEY WORDS: Brain metastases, radiotherapy, salvage, small‑cell lung cancer, stereotactic radiotherapy
INTRODUCTION Lung cancer is the most common malignancies and the leading cause of brain metastases (BM) in the United States. An estimated 277,000 deaths resulted from small‑cell lung cancer (SCLC) were reported in 2008.[1,2] Patients with SCLC are at high risk of developing BM. Previous studies suggested that prophylactic cranial irradiation (PCI) may reduce or delay the onset of BM.[3,4] A large European randomized trial has demonstrated a possible benefit of PCI treatment regimen in patients who were responsive to chemotherapy.[5] Until date, there are no established standard treatment recommendations for BM from SCLC.[6] For most patients, whole brain radiation therapy (WBRT) is the primary treatment option in clinical practice. However, recurrent lesions were reported and the repeated WBRT will cause intolerable side‑effect.[7,8] Stereotactic surgery (SRS) or SRT can be used in this condition. Most of the previously published randomized controlled trials did not include patients with BM from SCLC.[9,10] Several retrospective studies reported that the local control (LC) rate was 70‑95% and median overall survival (OS) was 4.5‑9 months in patients with BM from SCLC.[11‑13]
SRS was generally used for the treatment of BM patients with tumor size
