Rafael García1*, Amalia Sotoca1, Arturo Navarro-Martin2, Nuria Rodriguez de Dios3, Juan Sepúlveda4, Begoña Taboada5, Ricardo Diez-Valle4, Margarita Martín6, Sonia Tejada7, Maria Cruz Martin-Soberon8 and Felipe Couñago9,10
1Department of Radiation Oncology, Ruber International Hospital, Spain
2Department of Radiation Oncology, Duran and Reynals Hospital, Spain
3Department of Radiation Oncology, Sea Hospital, Spain
4Department of Neurology, Ruber International Hospital, Spain
5Department of Radiation Oncology, Santiago Clinic Hospital CHUS (Santiago University Clinical Hospital), Spain
6Department of Radiation Oncology, Ramon y Cajal Hospital, Spain
7Department of Neurosurgery, Jiménez Díaz Foundation University Hospital, Spain
8Department of Medical Oncology, University Hospital October 12, Spain
9Department of Radiation Oncology, University Hospital Quirónsalud Madrid, Spain 10Faculty of Biomedical Sciences and Health, European University, Spain
Purpose: The optimal management of BMs remains uncertain due to a lack of high level evidence (as reflected in the lack of consensus in the main clinical guidelines) and the scant data from Randomized Controlled Trials (RCT) in lung cancer patients with BMs, who have been specifically excluded from most trials. The aim of the present article is to review the multidisciplinary management surgery, radiotherapy, and systemic therapy of brain metastases in NSCLC.
Methods: A literature review was made in this study. Neurosurgeons, Medical Oncologists and Radiation Oncologists were involved to carry out a multidisciplinary review in order to offer the most appropriate evidence. At least two specialists per area performed a review using PubMed, Scopus and Cochrane databases.
Results: Three main treatment modalities were identified: Local treatment including surgery, radiotherapy and radiosurgery. The second one, Systemic treatments: chemotherapy, target therapies and immunotherapy and the last modality was the combination of local treatments and the systemic ones.
Conclusion: Surgery and stereotactic radiosurgery are established treatment strategies for patients with NSCLC who develop brain metastases; however the management of 4 brain metastases or more is under investigation. The use of systemic therapy to manage brain metastases in asymptomatic patients is gaining ground, especially in patients with driver mutations. Regarding combination of local treatment and systemic ones, the sequence and the use of concomitant treatment remains unclear. Several trials are trying to answer this question.
Brain metastases; SRS; Radiosurgery; Metastases
García R, Sotoca A, Navarro-Martin A, Rodriguez de Dios N, Sepúlveda J, Taboada B, et al. Comprehensive Management of Brain Metastases in Patients with Non-Small Cell Lung Cancer: Emerging Therapies. Clin Oncol. 2022;7:1921..