Journal Article

DKFZ-2023-00885

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Comparison of First-Line Radiosurgery for Small-Cell and Non-Small Cell Lung Cancer Brain Metastases (Cross-FIRE).

Rusthoven, C. G. ; Staley, A. W. ; Gao, D. ; Yomo, S. ; Bernhardt, D. ; Wandrey, N. ; El Shafie, R. ; Kraemer, A. ; Padilla, O. ; Chiang, V. ; Faramand, A. M. ; Palmer, J. D. ; Zacharia, B. E. ; Wegner, R. E. ; Hattangadi-Gluth, J. A. ; Levy, A. ; Bernstein, K. ; Mathieu, D. ; Cagney, D. N. ; Chan, M. D. ; Grills, I. S. ; Braunstein, S. ; Lee, C.-C. ; Sheehan, J. P. ; Kluwe, C. ; Patel, S. ; Halasz, L. M. ; Andratschke, N. ; Deibert, C. P. ; Verma, V. ; Trifiletti, D. M. ; Cifarelli, C. P. ; Debus, J.DKFZ* ; Combs, S. E. ; Sato, Y. ; Higuchi, Y. ; Aoyagi, K. ; Brown, P. D. ; Alami, V. ; Niranjan, A. ; Lunsford, L. D. ; Kondziolka, D. ; Camidge, D. R. ; Kavanagh, B. D. ; Robin, T. P. ; Serizawa, T. ; Yamamoto, M.

2023
Oxford Univ. Press Oxford

This record in other databases:  

Please use a persistent id in citations: doi:10.1093/jnci/djad073

Abstract: Historical reservations regarding radiosurgery (SRS) for small-cell-lung-cancer (SCLC) brain metastases (BrM) include concerns for short-interval/diffuse CNS-progression, poor prognoses, and increased neurological mortality specific to SCLC histology. We compared SRS outcomes for SCLC and non-small-cell-lung-cancer (NSCLC) where SRS is well established.Multicenter first-line SRS outcomes for SCLC and NSCLC from 2000-2022 were retrospectively collected (N=892-SCLC/N=4,785-NSCLC). Data from the prospective JLGK0901 SRS trial were analyzed as a comparison cohort (N=98-SCLC/N=794-NSCLC). OS and CNS-progression were analyzed using Cox-Proportional-Hazard and Fine-Gray models, respectively, with multivariable (MV) adjustment (including age/sex/performance-status/year/extracranial disease/BrM-number/BrM-volume). Mutation-stratified analyses were performed in propensity score-matched (PSM) retrospective cohorts of EGFR/ALK-positive-NSCLC, mutation-negative-NSCLC, and SCLC.OS was superior with NSCLC over SCLC in the retrospective dataset (median-OS, 10.5 vs 8.6 months, MV-p<0.001) and JLGK0901. Hazard estimates for first CNS-progression favoring NSCLC were similar in both datasets but reached significance in the retrospective dataset only (MV-HR:0.82 [95%-CI:0.73-0.92], p=0.001). In the PSM cohorts, there were continued OS advantages for NSCLC (median-OS, 23.7 [EGFR/ALK-positive-NSCLC] vs 13.6 [mutation-negative-NSCLC] vs 10.4 months [SCLC], pairwise-p-values<0.001), but no significant differences in CNS-progression. Neurological mortality and number of lesions at CNS-progression were similar for NSCLC and SCLC patients. Leptomeningeal-progression was increased in NSCLC patients in the retrospective dataset only (MV-HR:1.61 [95%-CI:1.14-2.26], p=0.007).After SRS, SCLC was associated with shorter OS compared to NSCLC. CNS progression occurred earlier in SCLC overall but was similar in patients matched on baseline characteristics. Neurological mortality, lesions at CNS-progression, and leptomeningeal-progression were comparable. These findings may better inform clinical decision-making for SCLC patients.

Keyword(s): brain metastases ; non-small cell lung cancer (NSCLC) ; small-cell lung cancer (SCLC) ; stereotactic radiosurgery (SRS) ; whole brain radiation therapy (WBRT)

Note: 2023 Aug 8;115(8):926-936

---

Contributing Institute(s):

1. DKTK HD zentral (HD01)

Research Program(s):

1. 899 - ohne Topic (POF4-899) (POF4-899)

Appears in the scientific report 2023

---

Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 10 ; JCR ; Nationallizenz ; PubMed Central ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

---