Methods and results of locoregional treatment of brain metastases in patients with non-small cell lung cancer

Abstract

This article presents methods and results of surgery and radiotherapy of brain metastases from non-small cell lung cancer (BMF-NSCLC). Patients with single BMF-NSCLC, with Karnofsky score ≥ 70 and controlled extracranial disease are the best candidates for surgery. Stereotactic radiosurgery (SRS) is recommended in patients with 1–3 BMF-NSCLC below 3–3.5 cm, with minor neurological symptoms, located in parts of the brain not accessible to surgery, with controlled extracranial disease. Whole brain radiotherapy (WBRT) following SRS reduces the risk of local relapse; in selected patients median survival reaches more than 10 months. Whole brain radiotherapy alone is a treatment in patients with multiple metastases, poor performance status, uncontrolled extracranial disease, disqualified from surgery or SRS with median survival 3 to 6 months. There is no doubt that there are patients with BMF-NSCLC who should receive only the best supportive care. There is a debate in the literature on how to select these patients.

Whole-Brain Radiation Therapy With Simultaneous Integrated Boost Versus Whole-Brain Radiation Therapy Plus Stereotactic Radiosurgery for the Treatment of Brain Metastasis From Lung Cancer

“…In some cancer centers, there are no criteria for administering SRS and WBRT is used an alternative strategy for patients with limited BM. However, WBRT alone only extends the median survival time by up to 6 months (9,10). WBRT plus in-field radiotherapy boost is an effective strategy for improving the intracranial control rate (ICR) and selecting patients who could experience significant survival benefits (11)(12)(13)(14)(15)(16)(17).…”

<p>Survival and intracranial control outcomes of whole-brain radiotherapy (WBRT) alone versus WBRT plus a radiotherapy boost in non-small-cell lung cancer with brain metastases: a single-institution retrospective analysis</p>

“…Radiotherapy, as an important treatment for controlling neurologic symptoms and prolonging survival, is widely used in patients with BMs. During the past 50 years, whole-brain radiotherapy (WBRT) has been the standard treatment for BMs, but WBRT alone has an unsatisfactory effect with an intracranial control rate (ICR) of 60% and a median survival of just 3–6 months 7,8. Several studies have shown that WBRT plus an in-field radiotherapy boost (RTB) for BMs could improve ICR versus WBRT alone, and select patients could experience significant survival benefits 9–12…”