Brain Tumors Lung Cancer Palliative Care

Less is More? Advancing Local Treatment for Small Cell Lung Cancer Brain Metastases

For our June #radonc #jc we will be shifting gears to shine light on our new normal. The last few months have seen medical practices worldwide alter the way we care for our patients including delaying, decreasing, or omitting treatments to help control the pandemic. We have also seen increased attention to radiation treatment for lung cancer while data for local treatment of lower burden metastatic disease continues to increase. 

Traditionally, small cell lung cancer (SCLC), a type of lung cancer, has received limited attention. Among all cancers worldwide it continues to be one of the deadliest, spreading early to distant sites such as the brain. Traditional management of these “Extensive-Stage” small cell lung cancers (ES-SCLC) has been prophylactic cranial radiation before intracranial spread (PCI) or whole brain radiation treatment (WBRT) for existing SCLC brain metastases, both with neurocognitive toxicities most notable for patients living longer or after repeat courses of radiation.

Newer techniques such as stereotactic radiosurgery (SRS) and improved access to MRI has changed the practice of other brain metastases. However, SCLC patients are excluded from many clinical trials contributing to the stagnant outcomes for these patients in the last decade.

This coming weekend, we will explore how to improve outcomes for SCLC with a focus on the recent results of the FIRE-SCLC Cohort Study:

Rusthoven C et al. Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases. JAMA Onc (2020)

This article will be temporarily Free Access for Medical Education from June 17-30th. Thanks to JAMA Oncology and Dr. Jack West for making it possible!

Dr. Chad Rusthoven, radiation oncologist from the University of Colorado Denver will join us this weekend to discuss his study, including for the live hour from 1 to 2pm Central Standard Time (CST) on Sunday, June 21, 2020. The asynchronous chat will start at 8AM CST on Saturday, June 20th to facilitate global participation.

We will focus on the following topics:

T1: What is the epidemiology of small cell lung cancer, and why are better treatments needed?

T2: What was the methodology of this study and for which practices and patients is it applicable?

T3: How do these results compare to other trials and current practices?

T4: Will these findings change practice or patient preferences? What is the need for prospective clinical trials?

T5: What role does your work play in the future direction of metastatic small cell lung cancer treatment and research?

Here are guidelines on how to sign up and participate

  • Read our disclaimer for ways to keep it rewarding and professional. If you’re not ready, just lurk and tune into the conversation.
  • If you feel like getting fancy, feel free to add #lcsm to your tweets to share with the breast cancer community on twitter. Just don’t forget the #radonc #jc tags!

Any suggestions? Leave a comment or tweet us at @Rad_Nation. And please join us this weekend!

References:

Rusthoven CG, Yamamoto M, Bernhardt D, et al. Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases: The FIRE-SCLC Cohort Study. JAMA Oncology. 2020. https://jamanetwork.com/journals/jamaoncology/article-abstract/2766565

Palma D, Olson R, et al. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol (in press) https://ascopubs.org/doi/10.1200/JCO.20.00818

Le Pechoux C, Levy A. Radiosurgery in Patients With Small Cell Lung Cancer With Brain Metastases: A Call for Prospective Evidence. JAMA Oncology. 2020. https://jamanetwork.com/journals/jamaoncology/article-abstract/2766562

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