Top Line: What is the risk of neurologic death after SRS for small cell lung cancer brain metastases?
The Study: SRS is commonplace in patients with limited brain metastases from just about any primary malignancy except SCLC. Granted, many of us use SRS in SCLC and it’s considered appropriate in the NCCN guidelines, but it can sometimes be challenging to get it approved by insurance. In this phase 2 trial, 100 patients with 1-10 brain metastases from SCLC (96%) or an extrathoracic small cell carcinoma (4%) who had no prior brain radiation (including PCI) were treated with SRS. The median number of mets was 2. Mets <2cm were treated with 20 Gy in 1 fraction, while larger lesions or those with a V12 >10cc (at a minimum prescription of 16 Gy x 1) received 30 Gy in 5 fractions. Most patients (64%) received single fraction SRS alone. Median OS was 10.4 months, and the primary endpoint of neurologic death occurred in 11% at 1 year and 20.3% at 2 years. In a comparison cohort of patients treated with whole brain RT for SCLC brain metastases, the rates of neurologic death were 17.5% at 1 year and 35.2% at 2 years. Intracranial progression occurred in 59% at 1 year, and 37% were treated with salvage SRS while 22% were treated with salvage WBRT.
TBL: In this phase 2 trial of SRS for patients with 1-10 brain metastases from SCLC, the rate of neurologic death was 11% at 1 year and 59% developed new brain metastases over that period. | Aizer, J Clin Oncol 2025
The Study: SRS is commonplace in patients with limited brain metastases from just about any primary malignancy except SCLC. Granted, many of us use SRS in SCLC and it’s considered appropriate in the NCCN guidelines, but it can sometimes be challenging to get it approved by insurance. In this phase 2 trial, 100 patients with 1-10 brain metastases from SCLC (96%) or an extrathoracic small cell carcinoma (4%) who had no prior brain radiation (including PCI) were treated with SRS. The median number of mets was 2. Mets <2cm were treated with 20 Gy in 1 fraction, while larger lesions or those with a V12 >10cc (at a minimum prescription of 16 Gy x 1) received 30 Gy in 5 fractions. Most patients (64%) received single fraction SRS alone. Median OS was 10.4 months, and the primary endpoint of neurologic death occurred in 11% at 1 year and 20.3% at 2 years. In a comparison cohort of patients treated with whole brain RT for SCLC brain metastases, the rates of neurologic death were 17.5% at 1 year and 35.2% at 2 years. Intracranial progression occurred in 59% at 1 year, and 37% were treated with salvage SRS while 22% were treated with salvage WBRT.
TBL: In this phase 2 trial of SRS for patients with 1-10 brain metastases from SCLC, the rate of neurologic death was 11% at 1 year and 59% developed new brain metastases over that period. | Aizer, J Clin Oncol 2025