Headline: Does SRS reduce neurocognitive decline for patients with small cell lung cancer brain metastases?
The Study: Although SRS is pretty much standard of care for patients with limited brain metastases for almost all malignancies, it’s still debated for SCLC. Data from the ENCEPHALON trial trial was recently presented at ASTRO 2023. It was a single center, randomized phase 2 trial of 56 patients with 1-10 SCLC brain metastases who were randomized to receive standard whole brain radiation or focal treatment with either single fraction or hypofractionated SRS (18-20 Gy x 1 or 30 Gy in 5 fractions for mets >3 cm). The primary endpoint of neurocognitive-decline, which was defined as a ≥ 5-point decline in the standardized Hopkins Verbal Learning Test–Revised at 3 months, was significantly worse after WBRT (24%) than SRS (8%). There was no difference in median overall survival between SRS and WBRT (4.1 v 4.4 months).
TBL: In this small randomized trial, SRS resulted in significantly less neurocognitive toxicity than WBRT for patients with limited SCLC brain metastases. | Bernhardt, ASTRO 2023
The Study: Although SRS is pretty much standard of care for patients with limited brain metastases for almost all malignancies, it’s still debated for SCLC. Data from the ENCEPHALON trial trial was recently presented at ASTRO 2023. It was a single center, randomized phase 2 trial of 56 patients with 1-10 SCLC brain metastases who were randomized to receive standard whole brain radiation or focal treatment with either single fraction or hypofractionated SRS (18-20 Gy x 1 or 30 Gy in 5 fractions for mets >3 cm). The primary endpoint of neurocognitive-decline, which was defined as a ≥ 5-point decline in the standardized Hopkins Verbal Learning Test–Revised at 3 months, was significantly worse after WBRT (24%) than SRS (8%). There was no difference in median overall survival between SRS and WBRT (4.1 v 4.4 months).
TBL: In this small randomized trial, SRS resulted in significantly less neurocognitive toxicity than WBRT for patients with limited SCLC brain metastases. | Bernhardt, ASTRO 2023