Abstract
PurposeThis study aimed to evaluate the survival outcomes of whole brain radiotherapy (WBRT) compared to whole brain radiotherapy plus local radiation boost (WBRT + boost), and further identify whether higher biologically effective dose (BED) of WBRT + boost translates into a survival benefit in small cell lung cancer (SCLC) patients with brain metastasis (BM).MethodsSCLC patients with BM from January 1, 2012, to December 31, 2019, were retrospectively analyzed. Overall survival (OS) and intracranial progression-free survival (iPFS) were evaluated by the Kaplan–Meier method and compared by the log-rank test. Univariate and multivariate regression analyses of prognostic factors for OS were performed using Cox proportional hazards regression models. The cutoff value of BED was determined by the receiver operating characteristic (ROC) curve analysis.ResultsAmong the 180 eligible patients, 82 received WBRT + boost and 98 received WBRT. Both OS and iPFS in the WBRT + boost group were significantly superior to those in the WBRT group (median OS: 20 vs. 14 months, p = 0.011; median iPFS: 16 vs. 10 months, p = 0.003). At a cutoff value of 58.35 Gy in the WBRT + boost group, 52 for the high-BED (>58.35 Gy) group, 30 for the low-BED (≤58.35 Gy) group. High BED was significantly associated with improved OS and iPFS compared with low BED in the WBRT + boost group (median OS: 23 vs. 17 months, p = 0.002; median iPFS: 17 vs. 10 months, p = 0.002).ConclusionsCompared with WBRT alone, WBRT + boost improved OS and iPFS in SCLC patients with BM. High BED (>58.35 Gy) for WBRT + boost may be a reasonable consideration for SCLC patients with BM.
Highlights
Small cell lung cancer (SCLC) is an aggressive form of lung cancer characterized by rapid dissemination and early metastasis [1, 2]
As there is no consensus on the optimal dose escalation of radiotherapy in SCLC patients with Brain metastasis (BM), we investigated the relationship between biologically effective dose (BED)-based dose escalation and survival outcomes in the whole brain radiotherapy (WBRT) + boost group
Another study analyzed 263 SCLC BM patients, and they found that WBRT + boost resulted in longer Overall survival (OS) than WBRT (17.9 vs. 8.7 months, p < 0.001) [13]
Summary
Small cell lung cancer (SCLC) is an aggressive form of lung cancer characterized by rapid dissemination and early metastasis [1, 2]. A large matchedcohort analysis, the FIRE-SCLC study, reported similar survival for upfront SRS versus WBRT for SCLC [9]. This indication remains controversial in SCLC patients. Several retrospective studies suggested that high biologically effective dose (BED) for brain radiotherapy could improve survival among SCLC patients with BM [14, 15]. This dose–response benefit suggests the value of evaluating BED in SCLC patients with BM. This study aimed to evaluate the survival benefits of WBRT + boost and WBRT in SCLC patients with BM and identify the dose–response benefit of BED in brain radiotherapy
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