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Whole-brain radiotherapy (WBRT) remains the standard of care for patients with brain metastases from small-cell lung cancer (SCLC) but is associated with neurocognitive toxicity. Stereotactic radiosurgery (SRS) is emerging as a potential treatment modality for brain metastases from SCLC, but studies on its uptake in SCLC remain limited. This National Cancer Database (NCDB) study examined clinical utilization trends and outcomes for WBRT vs. SRS for SCLC presenting with brain metastases. The NCDB was queried to identify newly diagnosed Stage IV SCLC patients with brain metastases between 2010-2017. A multivariate logistic regression model was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (95% CI) for receiving SRS. Survival analysis was performed using the Kaplan-Meier method and Cox regression modeling. The multivariate model included age, sex, race, insurance status, income, Charlson-Deyo comorbidity score, year of treatment, and facility type. Of 72,565 patients identified with Stage IV SCLC, 19,459 (26.8%) had brain metastases at diagnosis. The incidence of brain metastases rose from 24.9% in 2010 to 28.9% in 2017 (p for trend=0.002). There were 7,970 patients who received either WBRT in 5-20 fractions (n=7,611; 95.5%) or SRS in 1-5 fractions (n=359; 4.5%) as part of their initial treatment course. SRS use significantly increased from 3.1% in 2010 to 6.3% in 2017 (p for trend=0.002). Factors associated with SRS included treatment at academic/research (aOR 2.87 [95% CI, 1.72-4.79]; p<0.0001), comprehensive community (aOR 1.84 [1.10-3.07]; p=0.02), or integrated network facilities (aOR 2.16 [1.23-3.81]; p=0.008) vs. community sites. Age, sex, race, insurance status, income, and comorbidity score were not associated with receipt of SRS. Patients with extracranial metastases (liver, bone, and/or lung) were less likely to receive SRS than those without other sites of disease (3.7% vs. 5.4%; p=0.0006). Median follow-up was 7.1 months, and median survival was 7.3 months. Median survival for patients who received WBRT was 7.2 months vs. 8.9 months for SRS patients (p=0.004). On multivariate analysis, SRS was associated with improved survival vs. WBRT (hazard ratio [HR] 0.82 [0.72-0.93]; p=0.002). Younger age, female gender, Black race, private insurance, lower comorbidity score, and higher income were also associated with improved survival. The proportion of Stage IV SCLC presenting with brain metastases is increasing with time. While utilization of upfront SRS for brain metastases due to Stage IV SCLC has increased, WBRT remains the treatment modality used in >90% of cases. SRS is used less frequently at community facilities and when extracranial metastases are present, and is associated with improved survival compared to WBRT. [ABSTRACT FROM AUTHOR]

Timeliness of care is an important metric for lung cancer patients, and care delays in the safety-net setting have been described. However, timeliness from the point of the suspicious image is not well-studied. Herein, we evaluate time intervals in the workup of lung cancer at an urban, safety net hospital and assess for disparities by demographic and clinical factors. We performed a retrospective analysis of patients with lung cancer between 2015-2020. Median times from suspicious image to first treatment (I-T), suspicious image to diagnosis (I-D) and diagnosis to treatment (D-T) were calculated. Date of suspicious image was defined as the date that the imaging study prompting cancer-targeted workup resulted. Date of diagnosis was defined as date that biopsy first resulting in histologic diagnosis of lung cancer was performed. Non-parametric tests were applied to assess for intergroup differences in time intervals. A total of 687 patients were included in the final analysis, of whom 370 (53.9%) were male. By race, 328 (47.7%) were white, 248 (36.1%) were black, 47 (6.9%) were Hispanic, and the remaining 64 (9.3%) were of other racial groups. There were 235 stage I (34.2%), 54 stage II (7.9%), 125 stage III (18.2%), and 273 stage IV (39.7%) patients. I-T, I-D, and D-T for the entire cohort was 78, 34, and 32 days, respectively. Among females, the I-T was 87 days as compared to 72 days for males (p<0.01). By stage, the I-Ts were 106, 110, 81, and 41 days for stages I, II, III, and IV, respectively (p<0.01). The I-D was 40.5 and 45 days for black and Hispanic patients as compared to 28 and 23 days for white and Asian patients respectively (p<0.05, Table 1). Advanced stage at presentation and male gender were associated with more timely treatment from the point of suspicious imaging while non-black or Hispanic race were associated with more timely lung cancer diagnosis without significant impact on time to treatment. Future analyses should seek to elucidate the drivers of differences in timeliness of care by these characteristics and assess for the impact of timeliness disparities on patient outcomes in the safety net setting. [ABSTRACT FROM AUTHOR]