Author of

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  P3.13 - Poster Session 3 - SCLC (ID 202)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12729

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    P3.13-002 - Stereotactic radiosurgery for brain metastases after prophylactic cranial irradiation in limited disease small-cell lung cancer (ID 1137)

    09:30 - 09:30  |  Author(s): K. Sunami
    • Abstract

    Background
    Brain metastases are very common in patients with small-cell lung cancer (SCLC). Prophylactic cranial irradiation (PCI) has been shown to reduce the incidence of brain metastases and to improve overall survival in patients with limited-disease SCLC (LD-SCLC). However, brain metastases are often observed after PCI, and the optimal treatment for these brain metastases is still unclear. The present study investigated the recurrence of brain metastases after PCI in patients with LD-SCLC and the therapeutic efficacy of stereotactic radiosurgery for these metastases.

    Methods
    Between December 2000 and December 2012, 228 patients with LD-SCLC were treated and 98 of these patients with a complete response (CR) or a near CR to chemoradiotherapy underwent PCI at the National Cancer Center Hospital. We retrospectively reviewed the medical records and imaging data for these 98 patients.

    Results
    Twenty-four (24%) of the 98 patients developed brain metastases after PCI. The characteristics of the 24 patients were as follows: median age, 62 years (49-72 years), male/female, 21/3; performance status 0/1/2, 2/16/6. Twelve (50%) of the 24 patients had cranial recurrences only. Twelve patients had single brain metastases, and 12 patients had multiple lesions. Nine patients had neurological symptoms due to brain metastases. The median period after PCI until the appearance of the metastases was 9.9 months (1.1-34.9 months). Fifteen (63%) of the 24 patients underwent stereotactic radiosurgery (gamma knife radiosurgery [GKRS]), and one patient received whole brain radiotherapy. Six patients were treated with chemotherapy plus best supportive care (BSC), and two patients underwent BSC alone. The 15 patients who received GKRS had brain metastases with/without extracranial lesions (7 with, 8 without); three were symptomatic, and 12 were asymptomatic. The median number of brain metastases at the time of the first GKRS was one (range, 1-4). The local control rate of the lesions treated with GKRS was 86.7% (complete response in 3 patients, partial response in 7 patients, and stable disease in 3 patients). Five patients underwent further GKRS because of newly developing brain metastases (median: 4 times, range: 2-7 times). The median intracranial control time of the 15 patients was 6.8 months. The median survival time of the 15 patients was 29.3 months after the initial diagnosis, 13.7 months after the development of brain metastases, and 12.7 months after the treatment of GKRS. The median survival time of the patients without extracranial lesions was 20.2 months after the development of brain metastases and tended to be longer than that of the patients with extracranial lesions (12.6 months). Severe adverse events arising from GKRS were not observed in this series.

    Conclusion
    Stereotactic radiosurgery may be an effective option as a salvage therapy for brain metastases after PCI in patients with LD-SCLC.