Stereotactic radiation shows promise for small cell lung cancer with brain metastases

A new study led by investigators from Mass General Brigham trialed stereotactic (targeted) brain-directed radiation in 100 patients with small cell lung cancer and brain metastases, finding they experienced positive outcomes that support use of targeted radiation in the future for such patients. Results are published in the Journal of Clinical Oncology.

Despite being the historical standard, whole brain radiation might not be necessary for all patients. Our findings demonstrate that targeted, brain-directed radiation may be a viable treatment for patients with limited brain metastases from small cell lung cancer and potentially spare them from the side effects of whole brain radiation."

Ayal Aizer, MD, MHS, first author, director of Central Nervous System Radiation Oncology at Brigham and Women's Hospital

Currently, two major treatment options exist for patients being treated with brain metastases: whole brain radiation, which sends beams of radiation throughout the entire brain to kill tumor cells, and stereotactic radiation, which aims beams of radiation only at tumors. The targeted nature of stereotactic radiation creates fewer long-term side effects, but for patients with brain metastases from small cell lung cancer, it hasn't been tested in dedicated trials, until now.

Between 2018 and 2023, 100 patients with small cell lung cancer and 1-10 brain metastases were enrolled in this single arm, multi-center, phase 2 trial of stereotactic treatment. Comparing treatment with stereotactic radiation against whole brain radiation, the researchers found neurological death rate one-year post-treatment was 11% in their trial population versus the historical 17.5% rate in patients managed with whole brain radiation. Moreover, after initial treatment, most patients did not require subsequent whole brain radiation-likely due to the intensive brain monitoring built into the study protocol.

"These results support a shift toward more personalized, targeted treatment approaches that can help maintain quality of life while effectively managing brain metastases," Aizer said. "By avoiding whole brain radiation in select patients, we may be able to improve quality of life and reduce cognitive side effects without compromising outcomes."