TY - JOUR
T1 - Role of gamma knife radiosurgery in small cell lung cancer
T2 - A multi-institutional retrospective study of the international radiosurgery research foundation (IRRF)
AU - Cifarelli, Christopher P.
AU - Vargo, John A.
AU - Fang, Wei
AU - Liscak, Roman
AU - Guseynova, Khumar
AU - Warnick, Ronald E.
AU - Lee, Cheng Chia
AU - Yang, Huai Che
AU - Borghei-Razavi, Hamid
AU - Maiti, Tonmoy
AU - Siddiqui, Zaid A.
AU - Yuan, Justin C.
AU - Grills, Inga S.
AU - Mathieu, David
AU - Touchette, Charles J.
AU - Cordeiro, Diogo
AU - Chiang, Veronica
AU - Hess, Judith
AU - Tien, Christopher J.
AU - Faramand, Andrew
AU - Kano, Hideyuki
AU - Barnett, Gene H.
AU - Sheehan, Jason P.
AU - Lunsford, L. Dade
N1 - Publisher Copyright:
Copyright © 2020 by the Congress of Neurological Surgeons.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: Despite a high incidence of brain metastases in patients with small-cell lung cancer (SCLC), limited data exist on the use of stereotactic radiosurgery (SRS), specifically Gamma Knife™ radiosurgery (Elekta AB), for SCLC brain metastases. Objective: To provide a detailed analysis of SCLC patients treated with SRS, focusing on local failure, distant brain failure, and overall survival (OS). Methods: A multi-institutional retrospective review was performed on 293 patients undergoing SRS for SCLC brain metastases at 10 medical centers from 1991 to 2017. Data collectionwas performed according to individual institutional review boards, and analyses were performed using binary logistic regression, Cox-proportional hazardmodels, Kaplan- Meier survival analysis, and competing risks analysis. Results: Two hundred thirty-two (79%) patients received SRS as salvage following prior whole-brain irradiation (WBRT) or prophylactic cranial irradiation, with a median marginal dose of 18 Gy. At median follow-up after SRS of 6.4 and 18.0 mo for surviving patients, the 1-yr local failure, distant brain failure, and OS were 31%, 49%, and 28%. The interval between WBRT and SRS was predictive of improved OS for patients receiving SRS more than 1 yr after initial treatment (21%, <1 yr vs 36%, >1 yr, P = .01). On multivariate analysis, older age was the only significant predictor for OS (hazard ratio 1.63, 95% CI 1.16-2.29, P = .005). Conclusion: SRS plays an important role in the management of brain metastases from SCLC, especially in salvage therapy following WBRT. Ongoing prospective trials will better assess the value of radiosurgery in the primary management of SCLC brainmetastases and potentially challenge the standard application of WBRT in SCLC patients.
AB - Background: Despite a high incidence of brain metastases in patients with small-cell lung cancer (SCLC), limited data exist on the use of stereotactic radiosurgery (SRS), specifically Gamma Knife™ radiosurgery (Elekta AB), for SCLC brain metastases. Objective: To provide a detailed analysis of SCLC patients treated with SRS, focusing on local failure, distant brain failure, and overall survival (OS). Methods: A multi-institutional retrospective review was performed on 293 patients undergoing SRS for SCLC brain metastases at 10 medical centers from 1991 to 2017. Data collectionwas performed according to individual institutional review boards, and analyses were performed using binary logistic regression, Cox-proportional hazardmodels, Kaplan- Meier survival analysis, and competing risks analysis. Results: Two hundred thirty-two (79%) patients received SRS as salvage following prior whole-brain irradiation (WBRT) or prophylactic cranial irradiation, with a median marginal dose of 18 Gy. At median follow-up after SRS of 6.4 and 18.0 mo for surviving patients, the 1-yr local failure, distant brain failure, and OS were 31%, 49%, and 28%. The interval between WBRT and SRS was predictive of improved OS for patients receiving SRS more than 1 yr after initial treatment (21%, <1 yr vs 36%, >1 yr, P = .01). On multivariate analysis, older age was the only significant predictor for OS (hazard ratio 1.63, 95% CI 1.16-2.29, P = .005). Conclusion: SRS plays an important role in the management of brain metastases from SCLC, especially in salvage therapy following WBRT. Ongoing prospective trials will better assess the value of radiosurgery in the primary management of SCLC brainmetastases and potentially challenge the standard application of WBRT in SCLC patients.
KW - Gamma Knife
KW - Small-cell lung cancer
KW - Stereotactic radiosurgery
KW - Whole-brain radiation
UR - http://www.scopus.com/inward/record.url?scp=85088911461&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyz428
DO - 10.1093/neuros/nyz428
M3 - Article
C2 - 31599324
AN - SCOPUS:85088911461
SN - 0148-396X
VL - 87
SP - 664
EP - 671
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -
