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. 2024 May 31;13(5):1110-1120.
doi: 10.21037/tlcr-23-641. Epub 2024 May 29.

Outcomes of initial therapy for synchronous brain metastases from small cell lung cancer: a single-institution retrospective analysis

Kevin V Chaung  1 , Michael Z Kharouta  1   2 , Andrew J Gross  1 , Pingfu Fu  3 , Mitchell Machtay  1   4 , Tiffany R Hodges  5 , Andrew E Sloan  5   6 , Tithi Biswas  1   7 , Afshin Dowlati  8 , Serah Choi  1   9
Affiliations

Outcomes of initial therapy for synchronous brain metastases from small cell lung cancer: a single-institution retrospective analysis

Kevin V Chaung et al. Transl Lung Cancer Res. .

Abstract

Small cell lung cancer (SCLC) has a propensity for brain metastases, which is associated with poor prognosis. We sought to determine predictors of overall survival (OS) and brain progression-free survival (bPFS) in SCLC patients with synchronous brain metastases at the time of initial SCLC diagnosis. A total of 107 SCLC patients with synchronous brain metastases treated at a single institution were included in this retrospective analysis. These patients had brain lesions present on initial staging imaging. Survival was estimated using the Kaplan-Meier method with log-rank test. Factors predictive of OS and bPFS were analyzed using Cox proportional hazards regression model. Median OS for the entire cohort was 9 months (interquartile range, 4.2-13.8 months) and median bPFS was 7.3 months (interquartile range, 3.5-11.1 months). OS was 30.3% at 1 year and 14.4% at 2 years, while bPFS was 22.0% at 1 year and 6.9% at 2 years. The median number of brain lesions at diagnosis was 3 (interquartile range, 2-8), and the median size of the largest metastasis was 2.0 cm (interquartile range, 1.0-3.3 cm). Increased number of brain lesions was significantly associated with decreased OS. Patients who received both chemotherapy and whole brain radiation therapy (WBRT) had improved OS (P=0.02) and bPFS (P=0.005) compared to those who had either chemotherapy or WBRT alone. There was no significant difference in OS or bPFS depending on the sequence of therapy or the dose of WBRT. Thirteen patients underwent upfront brain metastasis resection, which was associated with improved OS (P=0.02) but not bPFS (P=0.09) compared to those who did not have surgery. The combination of chemotherapy and WBRT was associated with improved OS and bPFS compared to either modality alone. Upfront brain metastasis resection was associated with improved OS but not bPFS compared to those who did not have surgery.

Keywords: Small cell lung cancer (SCLC); brain metastases; chemotherapy; craniotomy; radiation therapy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-641/coif). T.R.H. reports receiving consulting fees from Medtronics which is not relevant to the work in this paper. T.B. reports funding from National Cancer Institute (NCI) Cancer Therapy Evaluation Program (CTEP) as national principle investigator (PI) of a clinical trial 04/22-3/23, which is not relevant to this study. A.D. reports participation in data safety monitoring board or advisory board on Ipsen, Amgen, Jazz, BMS, Astra Zeneca. S.C. reports receiving funding from the National Institutes of Health 01/20-11/23 (grant No. K12CA076917 to S.C. for salary support and research funds); participation in advisory boards for Telix Pharmaceuticals, Seagen Inc. and GT Medical. A.E.S. reports funding from U01 CS236215 06/19-5/23 (PI: Sloan), R01 CA 217956 06/17-05/22 (PI: Brady-Kalnay), R21 CA256573 01/21-12/22 (PI: Sloan), P01 CA CA245705-01 09/20-08/25 (PI: Lathia), Merck Case 3316 12/17-11/21 (PI: Sloan), Coulter Translational Research Fund 09/17-08/22 (PI: Brady-Kalnay), Jobs Ohio 5/22-11/23 (PI: Brady-Kalnay); options for <1% of company shares of Surgical Theater; consulting fees from Medtronic (Visualase), Monteris Medical Inc. and Surgical Theater; patents on the usage of PS-Binding CAR-T Cells and the procoagulant function of cancer stem cells. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study schema of retrospective study. SCLC, small cell lung cancer; WBRT, whole brain radiation therapy.
Figure 2
Figure 2
Kaplan-Meier curves for OS and bPFS for the SCLC synchronous brain metastases patient cohort (n=107 patients). OS, overall survival; bPFS, brain progression-free survival; SCLC, small cell lung cancer.
Figure 3
Figure 3
Kaplan-Meier curves for OS and bPFS for patients who received WBRT with 37.5 Gy in 15 fractions versus 30 Gy in 10 fractions. OS, overall survival; bPFS, brain progression-free survival; WBRT, whole brain radiation therapy.
Figure 4
Figure 4
Kaplan-Meier curves for OS and bPFS for patients who received upfront craniotomy (n=13 patients) for resection of SCLC synchronous brain metastases versus patients who did not undergo craniotomy (n=94 patients). OS, overall survival; bPFS, brain progression-free survival; SCLC, small cell lung cancer.
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