No Survival Benefit with Post-Chemo Stereotactic Radiosurgery in Non-Small Cell Lung Cancer

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In patients with non-small cell lung cancer, it is not well established whether patients with asymptomatic cerebral oligo-metastases have improved survival if their brain metastasis is treated before systemic chemotherapy compared with upfront chemotherapy.

For this reason, researchers conducted a controlled, randomized trial within a single center that included 105 patients with one to four brain metastases. The patients were enrolled between 2008 and 2013.

The patients were randomly assigned to treatment arms and 49 patients received stereotactic radiosurgery followed by chemotherapy and 49 patients received upfront chemotherapy. The primary end point of the study was overall survival, secondary end points were central nervous system progression-free survival, progression to symptomatic brain metastasis, and brain functional outcome. Patients enrolled had a median age of 58 (range 29-85).

Never smokers comprised 40% of the patients studied. Most patients had adenocarcinoma, and about 50% of patients had one brain metastasis, while the other half had multiple cerebral metastases. Patients receiving stereotactic radiosurgery followed by chemotherapy had a median overall survival of 14.6 months (95% confidence interval [CI], 9.2-20.0) and patients who received upfront chemotherapy had a median overall survival of 15.3 months (95% CI, 7.2-23.4) (P=0.418).

The researchers found no significant difference in time to central nervous disease progression between the two groups and symptomatic progression of brain metastases was more frequently seen in the group receiving upfront chemotherapy group (25.6% vs. 18.4%).

The researchers concluded that despite the small sample size within the study, patients with non-small cell lung cancer and oligo-brain metastases receiving stereotactic radiosurgery followed by chemotherapy did not see an improvement in overall survival compared with patients who received upfront chemotherapy.

Further research in a larger population is needed to confirm that use of upfront chemotherapy alone in this group of patients. 

There is debate regarding pasireotide for patients with pancreatic cancer undergoing surgery.
Non-small cell lung cancer and oligo-brain metastases receiving stereotactic radiosurgery did not see an improvement in survival.
It is unclear whether treating brain metastasis before starting systemic chemotherapy can improve survival compared with upfront chemotherapy in non-small-cell lung cancer (NSCLC) with asymptomatic cerebral oligo-metastases.

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