Whole-brain radiotherapy (WBRT) had been the standard of care for brain metastases (BMs) from small cell lung cancer (SCLC) in the past. However, for some SCLC patients, upfront stereotactic radiosurgery (SRS) gained popularity. Researchers sent an email invitation to Radiation Oncologists (ROs) in the United States to participate in an anonymous survey utilizing a branching logic system about their use of SRS and WBRT for SCLC BMs. To compare differences in continuous and categorical variables, the Wilcoxon rank-sum test and Fisher’s exact test were utilized. For outcome variables with P less than .10 on univariable analysis, multivariable logistic regression analyses with covariates were fitted. In total, 309 ROs responded to the research, with 290 (95.7%) saying they would have considered SRS for SCLC BMs in specific clinical situations. The quantity of BMs was the most strongly weighted feature across patient characteristics (mean 4.3/5 in importance), followed by performance status, cognitive function, and response to past therapy. SRS use was linked to the number of BMs (55.8% offered SRS “very frequently” [>75% of cases] or “often” [51% -75% of instances] for 1 BM vs 1.1% for >10 BM, P<.001). Concerns about rapid intracranial development (45.3%) and a lack of high-level data (36.7%) were the most relevant considerations in circumstances where WBRT was favored. The majority (60.6%) were aware of a large recent international retrospective analysis (the FIRE-SCLC study) that found similar OS between upfront SRS and WBRT; knowledge of the research was the only respondent variable that predicted SRS use for limited BMs (19.2% of those aware of the research preferred SRS for limited [≤4] BMs before publication vs 61% preferring SRS after publication, P<.001). The majority of respondents (88.2%) said they would have been prepared to enroll patients in the NRG-CC009 randomized trial, which compared SRS with hippocampal-avoidance WBRT. In the first survey of SRS for SCLC BMs, researchers found a high level of physician openness to upfront SRS in SCLC, especially for patients with few BMs, and a strong need to generate prospective randomized data to better understand the function of SRS in this population.

 

Link:www.sciencedirect.com/science/article/abs/pii/S1525730421001844