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Kepka. J Cancer Metastasis Treat 2019;5:53 Journal of Cancer
DOI: 10.20517/2394-4722.2018.114 Metastasis and Treatment

Review Open Access

Radiotherapy of brain metastases from small-cell
lung cancer: standards and controversies

Lucyna Kepka

Department of Radiation Oncology Military Institute of Medicine, Warsaw 04-141, Poland.
Correspondence to: Dr. Lucyna Kepka. Department of Radiation Oncology Military Institute of Medicine, Warsaw 04-141,
Poland. E-mail: lkepka@wim.mil.pl

How to cite this article: Kepka L. Radiotherapy of brain metastases from small-cell lung cancer: standards and controversies.
J Cancer Metastasis Treat 2019;5:53. http://dx.doi.org/10.20517/2394-4722.2018.114

Received: 31 Dec 2018 First Decision: 15 Apr 2019 Revised: 16 May 2019 Accepted: 16 May 2019 Published: 11 Jul 2019
Science Editor: Ira-Ida Skvortsova Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract

Small-cell lung cancer (SCLC) has a high propensity to metastasize into the brain. Radiotherapy plays a major role in
the treatment of brain metastases (BM) from SCLC. Whole-brain radiotherapy (WBRT) is the standard treatment of
BM from SCLC. However, the neurocognitive toxicity and modest efficacy of this approach have led to the increased
use of stereotactic radiosurgery. We have no strong evidence for the use of different forms of radiation (WBRT vs.
radiosurgery) in SCLC, because BM from this primary tumor were excluded from clinical trials. In this review, the use
of radiation in form of WBRT or radiosurgery is discussed in distinct clinical indications: as a primary treatment and
at relapse; without prior use of prophylactic cranial irradiation (PCI); and after PCI. Combinations of radiotherapy
with chemotherapy are discussed as BM in SCLC occur rarely as a sole event.

Keywords: Small-cell lung cancer, brain metastases, whole-brain radiotherapy, radiosurgery

INTRODUCTION
Small-cell lung cancer (SCLC) has a higher propensity than other solid tumors to spread to the brain. As
many as 40%-50% of SCLC patients will develop brain metastases (BM) during the course of their disease .
[1]
Apart from a higher risk of occurrence than in other cancers, BM from SCLC have distinct clinical
characteristics that differ from BM from all other solid tumors. These differences are reflected in radio-
and chemo-sensitivity and high aggressiveness with rapid propagation in the brain. The latter property
makes BM from SCLC hardly suitable for local treatment such as surgery or radiosurgery. Unlike BM from

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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