JAMA Oncol 2020 Jun 4
Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases: The FIRE-SCLC Cohort Study.
Related Questions
How do you approach a patient with a solitary brain metastasis from small cell lung cancer s/p resection with otherwise limited thoracic disease?
This is rather an uncommon situation but can happen if a patient presents with a synchronous solitary brain metastasis (with or w/o symptom) and undergoes craniotomy and resection only to find out that it is small cell lung cancer. Additional information is needed on the volume of intra-thoracic dis...
Does omission of PCI influence your decision whether to offer consolidative thoracic radiation in ES-SCLC after chemo + immunotherapy?
This is one of those stories that has evolved over time with our improvements in technology.EORTC 08993 (the Slotman study) demonstrated both an improvement in the rate of symptomatic brain mets at 1 yr from 40% to 15%, and an improvement in 1 yr OS from 13% to 27%. However, a huge caveat here is th...
How do you manage multiple brain metastases from small cell lung cancer?
In general, I think WBRT is a reasonable treatment for small-cell lung cancer (SCLC) brain metastases. That being said, our institution has considered SRS for select patients depending on a variety of factors as the treatment paradigm for this is evolving. There have been some studies addressing SRS...
How do you incorporate PCI into your management of patients with extensive stage SCLC?
The role of prophylactic cranial irradiation (PCI) in the modern era of brain MRI surveillance has been called into question and is the topic of the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- PCI (or hippocampal avoidance [HA]-PCI) for LS and ES-SCLC, where I serve as the prin...
Is it acceptable to treat newly diagnosed small cell lung cancer with limited brain metastasis with upfront SRS?
First, to be clear, there's not good evidence regarding the role of radiosurgery in small cell patients who have not had WBRT or PCI. In patients without brain metastases, there's a clearly defined and clinically significant survival benefit, which seems to result from both control of existing metas...