Dr Singh on Treating Lung Cancer CNS Metastasis Management Strategies

Raj Singh, MD, assistant professor, Radiation Oncology, The Ohio State University, Comprehensive Cancer Center — James, discusses the treatment of patients with lung cancer who develop central nervous system (CNS) metastases, highlighting how to best approach disease management in these patients.

At the 2024 ACRO Summit, Singh highlights key sessions from the meeting, including one that spotlighted the treatment of patients with CNS disease due to their lung cancer. This session featured Paul Brown, MD, of Mayo Clinic, who has been instrumental in conducting studies on neurocognitive outcomes in patients with brain metastases, Singh begins. Dr Brown’s research consistently demonstrates that the use of stereotactic radiosurgery, which targets specific brain lesions rather than employing whole-brain radiotherapy, does not compromise patient survival, Singh reports. Importantly, neurocognitive outcomes have improved with stereotactic radiosurgery compared with the standard approach, Singh says. However, small cell lung cancer (SCLC) presents a unique challenge among solid tumors due to the likelihood of patients developing micrometastatic disease in the brain, he notes.

Traditionally, patients experiencing partial or complete response after upfront chemoradiotherapy have been offered prophylactic cranial irradiation, despite presenting with no visible signs of brain disease, Singh elucidates, adding that criticism arises from the outdated nature of studies supporting this practice, which were conducted prior to the MRI era at a time when the accuracy of staging was limited.

Two crucial ongoing studies aim to address this concern by randomly assigning patients with limited-stage SCLC to receive either prophylactic cranial irradiation or observation with MRI surveillance, Singh continues. Additionally, a growing interest in the use of stereotactic radiosurgery for patients with SCLC brain metastases is challenging the historical reliance on whole-brain radiotherapy, he elucidates.

Retrospective studies have also found no survival differences for patients who received stereotactic radiosurgery vs those who received standard whole-brain radiotherapy, prompting ongoing research to compare these 2 approaches, with a focus on hippocampal sparing, Singh says. Accrual to these trials is eagerly awaited to provide insights into optimizing treatment strategies and simultaneously prioritizing neurocognitive quality of life for patients, he concludes.