Treatment and Prevention of Brain Metastases in Small Cell Lung Cancer.
Journal
American journal of clinical oncology
ISSN: 1537-453X
Titre abrégé: Am J Clin Oncol
Pays: United States
ID NLM: 8207754
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
pubmed:
11
10
2021
medline:
31
12
2021
entrez:
10
10
2021
Statut:
ppublish
Résumé
Central nervous system (CNS) metastasis will develop in 50% of small cell lung cancer (SCLC) patients throughout disease course. Development of CNS metastasis poses a particular treatment dilemma due to the accompanied cognitive changes, poor permeability of the blood-brain barrier to systemic therapy and relatively advanced state of disease. Survival of patients with untreated SCLC brain metastases is generally <3 months with whole brain radiotherapy used as first-line management in most SCLC patients. To prevent development of CNS metastasis prophylactic cranial irradiation (PCI) is recommended in limited stage disease, after response to chemotherapy and radiation, while PCI may be considered in extensive stage disease after favorable response to upfront treatment. Neurocognitive toxicity with whole brain radiotherapy and PCI is a concern and remains difficult to predict. The mechanism of toxicity is likely multifactorial, but a potential mechanism of injury to the hippocampus has led to hippocampal sparing radiation techniques. Treatment of established non-small cell lung cancer CNS metastases has increasingly focused on using stereotactic radiotherapy (SRS) and it is tempting to extrapolate these results to SCLC. In this review, we explore the evidence surrounding the prediction, prevention, detection, and treatment of CNS metastases in SCLC. We further review whether existing evidence supports extrapolating less toxic treatments to SCLC patients with CNS metastases and discuss trials that may shed more light on this question.
Identifiants
pubmed: 34628433
doi: 10.1097/COC.0000000000000867
pii: 00000421-202112000-00006
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
629-638Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
S.B. reports personal fees from AstraZeneca, personal fees from Bayer, personal fees from Boehringer-Ingelheim, personal fees from Bristol-Myers-Squibb, personal fees from GlaxoSmithKline, personal fees from Lilly, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Roche, personal fees from Takeda, outside the submitted work. D.E.D. reports advisory board attendance for Merck Canada, AstraZeneca, an honorarium for education content from Boehringer-Ingelheim, grants from Canada Institutes of Health Research, grants from CancerCare Manitoba Foundation, grants from Manitoba Medical Services Foundation, outside the submitted work. The remaining authors declare no conflicts of interest.
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