Brain Metastases From Small Cell Lung Cancer: Chemotherapy, Radiotherapy, or Both?

Brain metastasis is one of the most troublesome forms of metastatic disease in small cell lung cancer and is seen in more than half of the patients during the course of their disease. Treatment is very often indicated to improve the usually dramatic symptoms. Whole brain radiotherapy is effective with regard to improvement of clinical symptoms in the majority of the patients. Evaluation with currently used standard response criteria if it is used as a single treatment modality has unfortunately not been carried out in the reported studies. Chemotherapy results in roentgenologically documented responses in most patients who present with brain metastases at the time of diagnosis of small cell lung cancer. Patients relapsing in the brain after or during chemotherapy have the same chance to respond to second line chemotherapy in the brain as patients who are treated for a relapse at other sites. It is unclear if the combination of chemotherapy and radiotherapy is better than the single treatment modalities. For daily practice, whole brain radiotherapy still is considered as standard therapy for brain metastases of small cell lung cancer. However, if chemotherapy is administered for tumor outside the brain, one might delay the start of radiotherapy until the effect of the chemotherapy on the brain is known.