National Trends in Radiation Treatment for Small Cell Lung Cancer Brain Metastases in the Modern Era

Summary: Small cell lung cancer (SCLC) is a highly aggressive form of lung cancer that often leads to brain metastases. Traditional treatment has largely relied on whole-brain radiation therapy (WBRT). However, concerns about neurocognitive side effects have led to the adoption of advanced techniques like hippocampal avoidance WBRT (HA-WBRT) and stereotactic radiosurgery (SRS). This retrospective study utilized data from the National Cancer Database (NCDB) spanning from 2010 to 2021. The study included adult patients diagnosed with brain metastases from SCLC who received primary radiation therapy directed at the brain. Patients were categorized into three treatment groups: WBRT, HA-WBRT, and SRS. Statistical analyses, including logistic regression, Kaplan-Meier survival analysis, and Cox regression, were performed to identify predictors of treatment type and survival outcomes. The study analyzed 24,858 patients with a median age of 65 years. Over time, there was a significant increase in the use of advanced radiation techniques (HA-WBRT and SRS). SRS and HA-WBRT were associated with longer median survival (10.6 and 10.1 months, respectively) compared to WBRT (7.3 months). Factors such as advanced age, extracranial disease, and higher comorbidity scores were linked to poorer survival, while the use of chemotherapy, immunotherapy, and higher socioeconomic status were associated with improved outcomes. From 2010-2021, there has been an increase in the use of more advanced techniques to treat brain metastasis from SCLC. These advanced techniques were associated with improved survival outcomes, though selection bias and the retrospective nature of the study limit definitive conclusions. Jay H. Desai (he/him/his), n/a (Presenting Author) - Drexel University College of Medicine; Sujay Rajkumar, n/a (Co-Author) - Drexel University College of Medicine; Matthew Shepard, MD (Co-Author) - Allegheny Health Network, Department of Neurosurgery; Rodney E. Wegner, MD (Co-Author) - Allegheny Health Network Cancer Institute, Department of Radiation Oncology