Stereotactic radiosurgery (SRS) for small cell lung cancer (SCLC) brain metastases: a real-world UK tertiary center experience

Abstract Objectives Approximately 60% of patients with small cell lung cancer (SCLC) develop brain metastases (BM). Historically these have been managed with whole brain radiotherapy. We sought to compare outcomes with the FIRE-SCLC study which provided a benchmark median overall survival of 8.5 months (m). Methods We conducted a retrospective analysis of a prospectively collected dataset of patients with SCLC receiving stereotactic radiosurgery (SRS) for BM at our center from May 2016 to October 2024. The primary objective was mOS. Survival analysis was calculated from time of first SRS to death, performed on Prism 10.1.1. Extraction from electronic medical records was undertaken by authors, with local R&D approval. Results Forty patients were evaluable and 20% of patients (N = 8/40) received multiple treatments. The median follow-up time was 8.7 m. The median OS was 10.0 m. mOS of patients with 1 lesion was 13.8 m, vs. 8.4 m and 8.7 m for 2-4 and 5-10 BM. mOS for patients with KPS  ≥  90 was 12.4 m vs. 8.7 m for those with KPS ≤  80 (HR 1.63, P = .15). There was one death within 28 days of SRS. Five patients died within 90 days of SRS. Conclusion Median OS in this cohort of patients with SCLC BM compared favorably to the FIRE-SCLC cohort, supporting consideration in selected patients. Our cohort was limited by sample size. Further prospective research is needed to guide local therapies in ES-SCLC BM, particularly regarding adverse events. Advances in knowledge UK real-world data demonstrates survival outcomes with SRS for SCLC BM comparable to FIRE-SCLC, supporting feasibility under NHS commissioning criteria.