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Comment & Response
November 12, 2020

Deferring a Change in the Standard of Care for Small Cell Lung Cancer Brain Metastases

Author Affiliations
  • 1Department of Radiation Oncology, New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Oncol. 2021;7(1):134-135. doi:10.1001/jamaoncol.2020.5466

To the Editor I commend Rusthoven et al1 for the FIRE-SCLC (First-line Radiosurgery for Small-Cell Lung Cancer) collaborative 3-continent study of up-front stereotactic radiosurgery (SRS) in a large retrospective cohort (n = 710) of patients with small cell lung cancer (SCLC) brain metastases.1 Small cell lung cancer has a higher propensity for intracranial dissemination and shorter central nervous system (CNS) progression interval relative to other malignant neoplasms,2,3 and prophylactic cranial whole brain irradiation decreases brain metastasis development. Therefore, whole-brain radiotherapy (WBRT) is the standard of care for SCLC brain metastases, and SCLC has been excluded from sentinel SRS trials. Results of the FIRE-SCLC study, therefore, greatly inform SCLC SRS.

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