Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis

Karolina Gaebe¹, Alyssa Y Li¹, Amy Park¹, Ambica Parmar², Benjamin H Lok³, Arjun Sahgal⁴, Kelvin K W Chan⁵, Anders W Erickson⁶, Sunit Das⁷

Affiliations

¹ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
⁴ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁵ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁶ Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: sunit.das@utoronto.ca.

PMID: 35644163
DOI: 10.1016/S1470-2045(22)00271-6

Meta-Analysis

Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis

Karolina Gaebe et al. Lancet Oncol. 2022 Jul.

. 2022 Jul;23(7):931-939.

doi: 10.1016/S1470-2045(22)00271-6. Epub 2022 May 26.

Authors

Karolina Gaebe¹, Alyssa Y Li¹, Amy Park¹, Ambica Parmar², Benjamin H Lok³, Arjun Sahgal⁴, Kelvin K W Chan⁵, Anders W Erickson⁶, Sunit Das⁷

Affiliations

¹ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
⁴ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁵ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁶ Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: sunit.das@utoronto.ca.

PMID: 35644163
DOI: 10.1016/S1470-2045(22)00271-6

Abstract

Background: Patients with small-cell lung cancer (SCLC) are at high risk for intracranial metastatic disease (IMD). Although stereotactic radiosurgery (SRS) has supplanted whole brain radiotherapy (WBRT) as first-line treatment for IMD in most solid cancers, WBRT remains first-line treatment for IMD in patients with SCLC. We aimed to evaluate the efficacy of SRS in comparison with WBRT and assess treatment outcomes following SRS.

Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, CENTRAL, and grey literature sources for controlled trials and cohort studies published in English reporting on SRS for IMD treatment in patients with SCLC from inception to March 23, 2022. Studies were excluded that did not report on SRS for IMD secondary to SCLC. Summary data were extracted. The primary outcome was overall survival, presented as pooled hazard ratios (HR) through random-effects meta-analysis for studies comparing SRS with WBRT with or without SRS boost, and as medians for single-arm SRS studies. This study is registered with the Open Science Framework, DOI 10.17605/OSF.IO/8M4HC, and PROSPERO, CRD42021258197.

Findings: Of 3823 identified records, 31 were eligible for inclusion; seven were included in the meta-analysis. Overall survival following SRS was longer than following WBRT with or without SRS boost (HR 0·85; 95% CI 0·75-0·97; n=7 studies; n=18 130 patients), or WBRT alone (0·77; 0·72-0·83; n=7 studies; n=16 961 patients), but not WBRT plus SRS boost (1·17, 0·78-1·75; n=4 studies; n=1167 patients). Using single-arm studies, pooled median overall survival from SRS was 8·99 months (95% CI 7·86-10·16; n=14 studies; n=1682 patients). Between-study heterogeneity was considerable when pooled among all comparative studies (I²=71·9%).

Interpretation: These results suggest survival outcomes are equitable following treatment with SRS compared with WBRT in patients with SCLC and IMD. Future prospective studies should focus on tumour burden and differences in local and distant intracranial progression between WBRT-treated and SRS-treated patients with SCLC.

Funding: None.

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Conflict of interest statement

Declaration of interests BHL declares institution grants from AstraZeneca and Pfizer; and honoraria and support for travel or attending meetings from AstraZeneca. AS reports institution grants from Elekta AB and Varian; honoraria from (Medical Advisory Group and CNS Teaching Faculty), Elekta (Gamma Knife Icon) and Elekta AB, BrainLab, AstraZeneca, Medtronic Kyphon, Accuray, Merck, Abbvie, and Roche; support for attending meetings or travel from Elekta, Varian, and BrainLab; and acting as board member with International Stereotactic Radiosurgery Society (ISRS), co-chair of AO Spine Knowledge Forum Tumor, and member of Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases and Linac Based ISRS Consortia; and sitting on the advisory board with VieCure. SD received royalties from Oxford University Press; acts as a consultant for, and has received speaker fees from, Medexus; reports support for travel and accommodation from the Congress of Neurological Surgeons and the American Association of Neurological Surgeons; participated on a data safety monitoring board or advisory board for the Subcortical Surgery Group and XPan Medical; is the provincial lead Provincial Lead for CNS Cancers, Ontario Health, Cancer Care Ontario; and reports a research grant from Alkermes. All other authors declare no competing interests.

Comment in

Stereotactic radiosurgery for patients with small-cell lung cancer brain metastases.
Rieken S. Rieken S. Lancet Oncol. 2022 Jul;23(7):832-833. doi: 10.1016/S1470-2045(22)00301-1. Epub 2022 May 26. Lancet Oncol. 2022. PMID: 35644162 No abstract available.

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Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis

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Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis

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