SRS fails to improve survival for NSCLC brain metastases patients

Jan 28 2015

Phase III trial findings suggest that carrying out stereotactic radiosurgery (SRS) before chemotherapy does not improve overall survival for non-small-cell lung cancer (NSCLC) patients with asymptomatic brain metastases compared with chemotherapy alone.

In all, 49 patients with between one and four asymptomatic cerebral oligo-metastases were randomly assigned to receive SRS followed by chemotherapy, while 49 were given upfront chemotherapy alone. Chemotherapy was most commonly gemcitabine plus cisplatin or carboplatin, or pemetrexed plus cisplatin.

After a median follow-up of 43.0 months, the primary endpoint of median overall survival did not significantly differ between the SRS and upfront chemotherapy groups, at a median of 14.6 and 15.3 months, respectively.

There was a trend towards a shorter time to central nervous system (CNS) disease progression with SRS plus chemotherapy compared with chemotherapy alone (median, 9.4 vs 6.6 months), as well as a reduced risk of symptomatic progression of brain metastasis (18.4 vs 26.5%), and a trend towards a reduced need for salvage treatment.

But these differences between the treatment arms were not statistically significant, say Myung-Ju Ahn, from Sungkyunkwan University School of Medicine in Seoul, South Korea, and co-authors in the Annals of Oncology.

The overall response rate (ORR) of cranial disease was significantly higher for the SRS group than the upfront chemotherapy patients, at 57% versus 37%. However, the researchers observe that, while the upfront chemotherapy ORR was consistent with the high response rate in previous research, the SRS value was lower than hoped for.

“Given the lack of standard criteria for cranial response to SRS, the response we have observed may have been underestimated”, they admit.

The groups did not experience significant differences in the improvement or worsening of neurocognitive function over time.

“Given that SRS resulted in modest clinical benefit albeit without improved survival, and with no significant neurocognitive deterioration, treatment with SRS may be considered, but warrant[s] further research for its optimal use”, the researchers conclude.

Ann Oncol 2014; Advance online publication

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