Management of Brain Metastasis in Patients With Pulmonary Neuroendocrine Carcinomas

Rupesh Kotecha; Amy Zimmerman; Erin S Murphy; Zain Ahmed; Manmeet S Ahluwalia; John H Suh; Chandana A Reddy; Lilyana Angelov; Michael A Vogelbaum; Gene H Barnett; Samuel T Chao

doi:10.1177/1533034615589033

Management of Brain Metastasis in Patients With Pulmonary Neuroendocrine Carcinomas

Technol Cancer Res Treat. 2016 Aug;15(4):566-72. doi: 10.1177/1533034615589033. Epub 2015 Jun 3.

Authors

Affiliations

¹ Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
² Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.
³ Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.
⁵ Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA chaos@ccf.org.

PMID: 26041398
DOI: 10.1177/1533034615589033

Abstract

Background: The patterns of intracranial failure in patients with brain metastasis from pulmonary neuroendocrine carcinoma (PNEC) remain unknown.

Methods: From 1998 to 2013, 29 patients with the diagnosis of PNEC were treated for brain metastasis: 16 patients (55%) underwent whole-brain radiation therapy (WBRT), 5 (17%) patients underwent WBRT with a stereotactic radiosurgery (SRS) boost, and 8 (28%) patients underwent primary SRS alone.

Results: The median age at treatment was 61 years (range: 44-84 years) and the median follow-up was 9.6 months (0-157.4 months). Of the patients treated with SRS alone, 1 patient had radiographic local progression of disease and 1 patient had a distant intracranial failure. Of the patients treated with WBRT with or without an SRS boost, 9 patients developed intracranial progression, including 1 local failure. No differences in rates of intracranial progression or local failure between the 2 groups (P = .94 and P = .44, respectively) were observed. The actuarial rates of distant intracranial failure at 12 months were 32.9% (95% confidence interval [95% CI] 8.9%-56.8%) and 25% (95% CI 0.0%-67.4%) in patients undergoing primary WBRT or SRS, respectively (P = .31). The median overall survival was 15.8 months in patients treated with WBRT and 20.4 months in patients treated with primary SRS (P = .78).

Conclusion: Patients with brain metastasis from PNECs can be effectively treated with either WBRT or SRS alone, with a pattern of failure more consistent with non-small cell lung cancer than small cell lung cancer. In this series, there was not a statistically significant increased risk of distant intracranial failure when patients were treated with primary SRS.

Keywords: LCNEC; brain metastasis; lung; neuroendocrine; stereotactic radiosurgery; whole-brain radiation therapy.

MeSH terms

Adult
Aged
Aged, 80 and over
Brain Neoplasms / diagnosis
Brain Neoplasms / mortality
Brain Neoplasms / radiotherapy*
Brain Neoplasms / secondary*
Carcinoma, Neuroendocrine / pathology*
Combined Modality Therapy
Disease Management
Female
Humans
Kaplan-Meier Estimate
Lung Neoplasms / pathology*
Male
Middle Aged
Neoplasm Grading
Radiosurgery
Treatment Outcome
Tumor Burden