published in The Lancet Oncology suggests that targeted radiation therapy is equivalent to the current standard of care for patients whose lung cancer has spread to the brain.
The work, led by researchers at St. Michael’s Hospital, a Unity Health Toronto site, suggests that implementing this targeted approach, which is known to result in fewer negative cognitive impacts on patients, could potentially improve their care experience.
For patients with small cell lung cancer, a fast-growing disease that develops in the tissues of the lungs and often spreads to other parts of the body, brain metastasis is currently treated with whole-brain radiation therapy, which targets the whole brain. While this approach treats even microscopic tumors, it results in memory problems and impairs cognitive function. The alternative that conserves healthy brain tissue by targeting the tumor, called stereotactic radiosurgery, has less severe cognitive consequences, but has not yet been studied in patients with small cell lung cancer whose disease has spread to the brain.
“For years it made sense to treat these patients with whole-brain radiation because their survival was quite poor,” said Karolina Gaebe, a research student in Dr. Sunit Das, who led the investigation. dr. Das is a scientist at the Keenan Research Center for Biomedical Science and a neurosurgical oncologist at St. Michael’s Hospital in Toronto.
“For them, the long-term effects of the treatment were not as crucial as reducing the short-term impact of the disease. But now that treatments for their lung cancer have improved, these patients are surviving much longer.”
dr. Das, Gaebe and their team wanted to learn more after noting that patients with longer survival times also lived with severe cognitive impairment as a result of the treatments for their brain metastases. They wanted to understand whether a more targeted brain radiation regimen could be equally beneficial for these patients, similar to what has already been shown in most other cancer types.
As a first step, they performed this meta-analysis, reviewing the current literature to examine survival and brain outcomes after stereotactic radiosurgery for patients with small cell lung cancer that had spread to the brain. The team analyzed data from 31 studies and included 18,130 patients, the largest cohort of small cell lung cancer patients with brain metastases studied to date.
The team’s next goal is to launch a large, comprehensive clinical trial investigating the differences in cognitive outcomes between stereotactic radiosurgery and whole-brain radiation therapy in this patient population.
“Since this is a meta-analysis, we cannot use this as absolute evidence that all patients should be treated this way,” said Dr. tie. “But essentially this means challenging our global paradigms for treating patients with this disease and rethinking the idea that these patients should receive whole-brain radiation therapy.”
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