Treatment and Prevention of Brain Metastases in Small Cell Lung Cancer
- 11 October 2021
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in American Journal of Clinical Oncology
- Vol. 44 (12), 629-638
- https://doi.org/10.1097/coc.0000000000000867
Abstract
Central nervous system (CNS) metastasis will develop in 50% of small cell lung cancer (SCLC) patients throughout disease course. Development of CNS metastasis poses a particular treatment dilemma due to the accompanied cognitive changes, poor permeability of the blood-brain barrier to systemic therapy and relatively advanced state of disease. Survival of patients with untreated SCLC brain metastases is generally <3 months with whole brain radiotherapy used as first-line management in most SCLC patients. To prevent development of CNS metastasis prophylactic cranial irradiation (PCI) is recommended in limited stage disease, after response to chemotherapy and radiation, while PCI may be considered in extensive stage disease after favorable response to upfront treatment. Neurocognitive toxicity with whole brain radiotherapy and PCI is a concern and remains difficult to predict. The mechanism of toxicity is likely multifactorial, but a potential mechanism of injury to the hippocampus has led to hippocampal sparing radiation techniques. Treatment of established non–small cell lung cancer CNS metastases has increasingly focused on using stereotactic radiotherapy (SRS) and it is tempting to extrapolate these results to SCLC. In this review, we explore the evidence surrounding the prediction, prevention, detection, and treatment of CNS metastases in SCLC. We further review whether existing evidence supports extrapolating less toxic treatments to SCLC patients with CNS metastases and discuss trials that may shed more light on this question.Keywords
This publication has 101 references indexed in Scilit:
- Primary Analysis of a Phase II Randomized Trial Radiation Therapy Oncology Group (RTOG) 0212: Impact of Different Total Doses and Schedules of Prophylactic Cranial Irradiation on Chronic Neurotoxicity and Quality of Life for Patients With Limited-Disease Small-Cell Lung CancerEndocrine, 2011
- Clinical neurological outcome and quality of life among patients with limited small-cell cancer treated with two different doses of prophylactic cranial irradiation in the intergroup phase III trial (PCI99-01, EORTC 22003-08004, RTOG 0212 and IFCT 99-01)Annals of Oncology, 2011
- Cognitive Sparing during the Administration of Whole Brain Radiotherapy and Prophylactic Cranial Irradiation: Current Concepts and ApproachesJournal of Oncology, 2010
- The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guidelineJournal of Neuro-Oncology, 2009
- A phase III trial of topotecan and whole brain radiation therapy for patients with CNS-metastases due to lung cancerBritish Journal of Cancer, 2009
- Prophylactic Cranial Irradiation in Extensive Disease Small-Cell Lung Cancer: Short-Term Health-Related Quality of Life and Patient Reported Symptoms—Results of an International Phase III Randomized Controlled Trial by the EORTC Radiation Oncology and Lung Cancer GroupsJournal of Clinical Oncology, 2009
- Role of palliative radiotherapy in brain metastasesIndian Journal of Palliative Care, 2009
- Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: Results of a multicentre randomised trialEuropean Journal of Cancer, 1997
- Resection of a solitary brain metastasis in a patient with small cell lung cancer—Long-term survivalEuropean Journal of Cancer, 1995
- Carboplatin as second line treatment for recurrent or progressive brain metastases from small cell lung cancerEuropean Journal of Cancer, 1993