Retrospective population-based cohort study of brain metastasis burden and management in patients with small cell lung cancer

Patients with small cell lung cancer (SCLC) have a poor prognosis and high risk of brain metastasis (BM). A population-based retrospective cohort study in Ontario, Canada, investigated clinical characteristics and outcomes of patients with SCLC and BM. BMs were seen in 32% of the patients (43.7% synchronous and 56.3% asynchronous). Median OS of patients with BMs was 9.76 months (95% CI 9.36-10.22). Four percent of patients received stereotactic radiosurgery (SRS) whereas 62% received whole brain radiation therapy, and 35% received no treatment for BM in the first-line setting or after prophylactic cranial irradiation. Among patients who received PCI prior to BM development, SRS was associated with better overall survival from the time of BM diagnosis when compared with WBRT (HR 0.47; p=0.0042). Among patients who did not receive PCI before BM development OS was not significantly different between SRS- and WBRT-treated cohorts (HR 0.68; p=0.091). The authors conclude that OS for patients with SCLC remains poor, and many patients present with BM. Patients with SCLC and BM may benefit from SRS treatment.