Radiosurgery in Patients With Small Cell Lung Cancer With Brain Metastases: A Call for Prospective Evidence
Menée à partir de données portant sur 710 patients présentant des métastases cérébrales ayant pour origine un cancer du poumon à petites cellules (âge médian : 68,5 ans ; 531 hommes), cette étude multicentrique évalue l'efficacité, du point de vue de la survie globale, de la survie sans progression au niveau du système nerveux central et du délai avant progression des métastases, d'une radiochirurgie stéréotaxique de première ligne ciblant les métastases par rapport à une radiothérapie de l'ensemble du cerveau
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. 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, there has been a shift toward delivering SRS also for patients with SCLC with brain metastases.
JAMA Oncology , éditorial, 2019