Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer

Sunit Harris, Michael D. Chan, James F. Lovato, Thomas L. Ellis, Stephen B. Tatter, J. Daniel Bourland, Michael T. Munley, Allan F. Deguzman, Edward G. Shaw, James J. Urbanic, Kevin P. McMullen

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Purpose: Radiosurgery has been successfully used in selected cases to avoid repeat whole-brain irradiation (WBI) in patients with multiple brain metastases of most solid tumor histological findings. Few data are available for the use of radiosurgery for small-cell lung cancer (SCLC). Methods and Materials: Between November 1999 and June 2009, 51 patients with SCLC and previous WBI and new brain metastases were treated with GammaKnife stereotactic radiosurgery (GKSRS). A median dose of 18 Gy (range, 10-24 Gy) was prescribed to the margin of each metastasis. Patients were followed with serial imaging. Patient electronic records were reviewed to determine disease-related factors and clinical outcomes after GKSRS. Local and distant brain failure rates, overall survival, and likelihood of neurologic death were determined based on imaging results. The Kaplan-Meier method was used to determine survival and local and distant brain control. Cox proportional hazard regression was performed to determine strength of association between disease-related factors and survival. Results: Median survival time for the entire cohort was 5.9 months. Local control rates at 1 and 2 years were 57% and 34%, respectively. Distant brain failure rates at 1 and 2 years were 58% and 75%, respectively. Fifty-three percent of patients ultimately died of neurologic death. On multivariate analysis, patients with stable (hazard ratio [HR] = 2.89) or progressive (HR = 6.98) extracranial disease (ECD) had worse overall survival than patients without evidence of ECD (p = 0.00002). Concurrent chemotherapy improved local control (HR = 89; p = 0.006). Conclusions: GKSRS represents a feasible salvage option in patients with SCLC and brain metastases for whom previous WBI has failed. The status of patients' ECD is a dominant factor predictive of overall survival. Local control may be inferior to that seen with other cancer histological results, although the use of concurrent chemotherapy may help to improve this.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number1
DOIs
StatePublished - May 1 2012
Externally publishedYes

Fingerprint

Salvage Therapy
Radiosurgery
Small Cell Lung Carcinoma
lungs
brain
radiation therapy
therapy
Radiotherapy
cancer
Brain
metastasis
hazards
Survival
Neoplasm Metastasis
chemotherapy
death
Nervous System
irradiation
Safety Management
Drug Therapy

Keywords

  • Brain metastases
  • Small cell lung cancer
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer. / Harris, Sunit; Chan, Michael D.; Lovato, James F.; Ellis, Thomas L.; Tatter, Stephen B.; Bourland, J. Daniel; Munley, Michael T.; Deguzman, Allan F.; Shaw, Edward G.; Urbanic, James J.; McMullen, Kevin P.

In: International Journal of Radiation Oncology Biology Physics, Vol. 83, No. 1, 01.05.2012.

Research output: Contribution to journalArticle

Harris, S, Chan, MD, Lovato, JF, Ellis, TL, Tatter, SB, Bourland, JD, Munley, MT, Deguzman, AF, Shaw, EG, Urbanic, JJ & McMullen, KP 2012, 'Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer', International Journal of Radiation Oncology Biology Physics, vol. 83, no. 1. https://doi.org/10.1016/j.ijrobp.2011.11.059
Harris, Sunit ; Chan, Michael D. ; Lovato, James F. ; Ellis, Thomas L. ; Tatter, Stephen B. ; Bourland, J. Daniel ; Munley, Michael T. ; Deguzman, Allan F. ; Shaw, Edward G. ; Urbanic, James J. ; McMullen, Kevin P. / Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 83, No. 1.
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AU - Ellis, Thomas L.

AU - Tatter, Stephen B.

AU - Bourland, J. Daniel

AU - Munley, Michael T.

AU - Deguzman, Allan F.

AU - Shaw, Edward G.

AU - Urbanic, James J.

AU - McMullen, Kevin P.

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KW - Small cell lung cancer

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