• Christopher P Cifarelli, John A Vargo, Wei Fang, Roman Liscak, Khumar Guseynova, Ronald E Warnick, Cheng-Chia Lee, Huai-Che Yang, Hamid Borghei-Razavi, Tonmoy Maiti, Zaid A Siddiqui, Justin C Yuan, Inga S Grills, David Mathieu, Charles J Touchette, Diogo Cordeiro, Veronica Chiang, Judith Hess, Christopher J Tien, Andrew Faramand, Hideyuki Kano, Gene H Barnett, Jason P Sheehan, and L Dade Lunsford.
• Department of Neurosurgery, School of Medicine, West Virginia University, Morgantown, West Virginia.
• Neurosurgery. 2020 Sep 15; 87 (4): 664-671.

BackgroundDespite 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.ObjectiveTo provide a detailed analysis of SCLC patients treated with SRS, focusing on local failure, distant brain failure, and overall survival (OS).MethodsA multi-institutional retrospective review was performed on 293 patients undergoing SRS for SCLC brain metastases at 10 medical centers from 1991 to 2017. Data collection was performed according to individual institutional review boards, and analyses were performed using binary logistic regression, Cox-proportional hazard models, Kaplan-Meier survival analysis, and competing risks analysis.ResultsTwo 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).ConclusionSRS 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 brain metastases and potentially challenge the standard application of WBRT in SCLC patients.Copyright © 2019 by the Congress of Neurological Surgeons.

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