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Invited Commentary
June 4, 2020

Radiosurgery in Patients With Small Cell Lung Cancer With Brain Metastases: A Call for Prospective Evidence

Author Affiliations
  • 1Department of Radiation Oncology, Institut d’Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France
  • 2Univ Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
  • 3INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
JAMA Oncol. 2020;6(7):1037-1038. doi:10.1001/jamaoncol.2020.1245

Small cell lung cancer (SCLC) is characterized by a rapid doubling time and fast dissemination, particularly to the brain. More than 50% of patients with SCLC will have brain failure during the course of their disease. Baseline screening and higher access to brain magnetic resonance imaging (MRI) have also enabled the earlier detection of brain metastases. Partly owing to the frequency of brain metastases responsible for life-threatening and debilitating symptoms as well as serious impairment of quality of life, metastatic SCLC is associated with poor outcome, with less than 5% of patients surviving beyond 2 years.1 Management of SCLC with brain metastases has not changed over the past 20 years and relies essentially on whole-brain radiotherapy (WBRT) in case of symptomatic brain metastases and/or chemotherapy. In particular, owing to the limited survival and because brain metastases are often multiple and diffuse with possible micrometastases, patients with SCLC were not included in trials evaluating stereotactic radiosurgery (SRS). However, with higher access to SRS, prospective, nonrandomized clinical trial data suggesting that several (up to 10) metastases may be treated with similar efficacy as a more limited number and because of concerns of WBRT-related neurotoxic effects,1,2 there has been a shift toward delivering SRS also for patients with SCLC with brain metastases.

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