Emerging Trends in the Management of Brain Metastases from Non-small Cell Lung Cancer

Thomas M. Churilla; Stephanie E. Weiss

doi:10.1007/s11912-018-0695-9

Emerging Trends in the Management of Brain Metastases from Non-small Cell Lung Cancer

Thomas M. Churilla, Stephanie E. Weiss

Fox Chase Cancer Center

Research output: Contribution to journal › Review article › peer-review

15 Scopus citations

Abstract

Purpose of Review: To summarize current approaches in the management of brain metastases from non-small cell lung cancer (NSCLC). Recent Findings: Local treatment has evolved from whole-brain radiotherapy (WBRT) to increasing use of stereotactic radiosurgery (SRS) alone for patients with limited (1–4) brain metastases. Trials have established post-operative SRS as an alternative to adjuvant WBRT following resection of brain metastases. Second-generation TKIs for ALK rearranged NSCLC have demonstrated improved CNS penetration and activity. Current brain metastasis trials are focused on reducing cognitive toxicity: hippocampal sparing WBRT, SRS for 5–15 metastases, pre-operative SRS, and use of systemic targeted agents or immunotherapy. Summary: The role for radiotherapy in the management of brain metastases is becoming better defined with local treatment shifting from WBRT to SRS alone for limited brain metastases and post-operative SRS for resected metastases. Further trials are warranted to define the optimal integration of newer systemic agents with local therapies.

Original language	English
Article number	54
Pages (from-to)	54
Journal	Current Oncology Reports
Volume	20
Issue number	7
DOIs	https://doi.org/10.1007/s11912-018-0695-9
State	Published - Apr 7 2018

Keywords

Brain metastases
Immunotherapy
Non-small cell lung cancer
Radiotherapy
SRS
SRT
Stereotactic radiation therapy
Stereotactic radiosurgery
Targeted therapy
WBRT
Whole brain radiotherapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s11912-018-0695-9

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title = "Emerging Trends in the Management of Brain Metastases from Non-small Cell Lung Cancer",

abstract = "Purpose of Review: To summarize current approaches in the management of brain metastases from non-small cell lung cancer (NSCLC). Recent Findings: Local treatment has evolved from whole-brain radiotherapy (WBRT) to increasing use of stereotactic radiosurgery (SRS) alone for patients with limited (1–4) brain metastases. Trials have established post-operative SRS as an alternative to adjuvant WBRT following resection of brain metastases. Second-generation TKIs for ALK rearranged NSCLC have demonstrated improved CNS penetration and activity. Current brain metastasis trials are focused on reducing cognitive toxicity: hippocampal sparing WBRT, SRS for 5–15 metastases, pre-operative SRS, and use of systemic targeted agents or immunotherapy. Summary: The role for radiotherapy in the management of brain metastases is becoming better defined with local treatment shifting from WBRT to SRS alone for limited brain metastases and post-operative SRS for resected metastases. Further trials are warranted to define the optimal integration of newer systemic agents with local therapies.",

keywords = "Brain metastases, Immunotherapy, Non-small cell lung cancer, Radiotherapy, SRS, SRT, Stereotactic radiation therapy, Stereotactic radiosurgery, Targeted therapy, WBRT, Whole brain radiotherapy",

author = "Churilla, {Thomas M.} and Weiss, {Stephanie E.}",

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AU - Weiss, Stephanie E.

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N2 - Purpose of Review: To summarize current approaches in the management of brain metastases from non-small cell lung cancer (NSCLC). Recent Findings: Local treatment has evolved from whole-brain radiotherapy (WBRT) to increasing use of stereotactic radiosurgery (SRS) alone for patients with limited (1–4) brain metastases. Trials have established post-operative SRS as an alternative to adjuvant WBRT following resection of brain metastases. Second-generation TKIs for ALK rearranged NSCLC have demonstrated improved CNS penetration and activity. Current brain metastasis trials are focused on reducing cognitive toxicity: hippocampal sparing WBRT, SRS for 5–15 metastases, pre-operative SRS, and use of systemic targeted agents or immunotherapy. Summary: The role for radiotherapy in the management of brain metastases is becoming better defined with local treatment shifting from WBRT to SRS alone for limited brain metastases and post-operative SRS for resected metastases. Further trials are warranted to define the optimal integration of newer systemic agents with local therapies.

AB - Purpose of Review: To summarize current approaches in the management of brain metastases from non-small cell lung cancer (NSCLC). Recent Findings: Local treatment has evolved from whole-brain radiotherapy (WBRT) to increasing use of stereotactic radiosurgery (SRS) alone for patients with limited (1–4) brain metastases. Trials have established post-operative SRS as an alternative to adjuvant WBRT following resection of brain metastases. Second-generation TKIs for ALK rearranged NSCLC have demonstrated improved CNS penetration and activity. Current brain metastasis trials are focused on reducing cognitive toxicity: hippocampal sparing WBRT, SRS for 5–15 metastases, pre-operative SRS, and use of systemic targeted agents or immunotherapy. Summary: The role for radiotherapy in the management of brain metastases is becoming better defined with local treatment shifting from WBRT to SRS alone for limited brain metastases and post-operative SRS for resected metastases. Further trials are warranted to define the optimal integration of newer systemic agents with local therapies.

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KW - Immunotherapy

KW - Non-small cell lung cancer

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KW - Stereotactic radiation therapy

KW - Stereotactic radiosurgery

KW - Targeted therapy

KW - WBRT

KW - Whole brain radiotherapy

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Emerging Trends in the Management of Brain Metastases from Non-small Cell Lung Cancer

Abstract

Keywords

UN SDGs

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