Whole-brain radiotherapy useful in seniors with small cell lung cancer with brain metastasis
Whole-brain radiotherapy (WBRT) confers a slight survival benefit for elderly small cell lung cancer (SCLC) patients with brain metastasis unfit for chemotherapy, a recent study has shown.
Of the 1,615 enrolled SCLC patients (age ≥75 years; 51 percent female), 576 received both chemotherapy and WBRT, 238 received chemotherapy alone and 360 were given WBRT alone. The remaining 441 patients did not receive any treatment.
In patients not on chemotherapy, median overall survival (OS) was modestly but significantly higher in those who did vs did not receive WBRT (1.9 vs 1.2 months; p<0.0001). Multivariable Cox regression analysis further confirmed the survival benefit of WBRT (hazard ratio [HR], 0.71, 95 percent CI, 0.61–0.82; p<0.0001).
Increasing age, on the other hand, was revealed to be a significant risk factor for death in the no-chemotherapy group (HR, 1.17, 1.01–1.35; p=0.0336).
In those who were receiving chemotherapy, on the other hand, WBRT did not seem to play an important role in survival. Median OS in those with vs without WBRT were 5.6 and 6.4 months, respectively (p=0.43).
Multivariable Cox regression analysis identified age >80 years (HR, 1.34, 1.15–1.57; p=0.0002), extracranial metastasis (HR, 1.30, 1.12–1.50), the male sex (HR for females, 0.85, 0.74–0.99; p=0.028) and rural location (HR, 1.94, 1.13–3.31; p=0.014) as significant predictors of death. WBRT failed to reach significance (HR, 1.12; 0.95–1.32; p=0.18).
“[I]n patients without neurologic symptoms, the omission of WBRT in lieu of radiosurgery or palliative measures only might be considered in select patients,” said researchers.