Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

Mantovani, Cristina; Gastino, A.; Cerrato, M.; Badellino, Serena; Ricardi, Umberto; Levis, Mario

doi:10.3389/fonc.2021.772789

Cited by 36 publications

(36 citation statements)

References 158 publications

(234 reference statements)

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“…For metastatic lung adenocarcinoma, local radiation therapy is recommended for palliation of symptoms and can be used for consolidation in oligo-metastatic or oligo-residual tumors ( 6 ). For brain metastasis, both radiosurgery and whole brain irradiation are important treatment options to control intracranial tumors ( 7 ). Therefore, the method to improve radiation response and the study on the radioresistance in lung adenocarcinoma are necessary.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Galectin-1 but Not Galectin-3 in Patients With Lung Adenocarcinoma After Radiation Therapy

Huang

Chuang

et al. 2022

Front. Oncol.

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IntroductionTo investigate the role of tumor galectin-1 and galectin-3 in patients with lung adenocarcinoma after definitive radiation therapy.MethodsA total of 41 patients with localized lung adenocarcinoma undergoing thoracic radiation therapy without concurrent chemotherapy were enrolled. Their paraffin-embedded lung tissues were sent for immunohistochemical staining for galectin-1 and galectin-3. The clinical treatment outcomes, including overall (OS), locoregional progression-free (LRPFS), and distant metastasis-free (DMFS) survivals, were evaluated. Univariable and multivariable Cox regression analyses were applied.ResultsOverexpression of tumor galectin-1 and galectin-3 were found in 26.8% and 19.5% of patients, respectively. Overexpression of tumor galectin-1 was the most significant prognosticator to predict worse LRPFS in both univariable (p = 0.007) and multivariable analyses (p = 0.022). Besides, patients with overexpression of tumor galectin-1 had a trend of worse OS (p = 0.066) than those with low expression in multivariable analysis, and worse DMFS (p = 0.035) in univariable analysis. The overexpression of tumor galectin-3 had no significant effect on survival outcomes.ConclusionsThe overexpression of tumor galectin-1, but not galectin-3, is associated with poor LRPFS of patients with lung adenocarcinoma after thoracic radiation therapy. Future research on the mechanism of galectin-1 affecting radiation response in lung adenocarcinoma may be worth exploring.

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Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Galectin-1 but Not Galectin-3 in Patients With Lung Adenocarcinoma After Radiation Therapy

Huang

Chuang

et al. 2022

Front. Oncol.

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“…Prabhu et al in 2017 conducted a retrospective, multiinstitutional study of 213 patients to determine outcomes of SRS alone or SRS plus surgery (60). 223 large brain metastases (≥4cm) were treated with either SRS alone (61), NSRS and surgery (62), or surgery with adjuvant SRS (94). Any complete resection with SRS was associated with improved local control (79.5%) compared with SRS alone (63.3%).…”

Section: Neo-adjuvant Srs Followed By Surgerymentioning

confidence: 99%

“…In non-small-cell lung cancer (NSCLC), brain metastases may arise in 30% of patients in their disease course (61,67). A unique subset of tumors carry the ALK rearrangement, which make these patients excellent candidates for targeted treatment with ALK-targeted tyrosine kinase inhibitors (TKI), including crizotinib.…”

Section: Histologic Considerations In Treatmentmentioning

confidence: 99%

Management Strategies for Large Brain Metastases

2022

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Brain metastases represent the most common intracranial neoplasm and pose a significant disease burden on the individual and the healthcare system. Although whole brain radiation therapy was historically a first line approach, subsequent research and technological advancements have resulted in a larger armamentarium of strategies for treatment of these patients. While chemotherapeutic options remain limited, surgical resection and stereotactic radiosurgery, as well as their combination therapies, have shifted the paradigms for managing intracranial metastatic disease. Ultimately, no single treatment is shown to be consistently effective across patient groups in terms of overall survival, local and distant control, neurocognitive function, and performance status. However, close consideration of patient and tumor characteristics may help delineate more favorable treatment strategies for individual patients. Here the authors present a review of the recent literature surrounding surgery, whole brain radiation therapy, stereotactic radiosurgery, and combination approaches.

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“…For brain lesions, SRS was offered to treat small or unresectable BMs with a riskadapted approach depending on tumor diameter [20,21]. With a prescription dose of 18-21 Gy, SRS was preferred for lesions < 2 cm, while surgery or SRT were preferred when treating lesions with a diameter > 2 cm.…”

Section: Treatment Detailsmentioning

confidence: 99%

Role of Radiosurgery and Stereotactic Ablative Radiotherapy for Oligometastatic Non-Oncogene Addicted NSCLC

Badellino

Levis

Cuffini

et al. 2022

Cancers

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Local ablative therapy (LAT), intended as stereotactic ablative radiotherapy or stereotactic radiosurgery, is a well-recognized effective treatment for selected patients with oligometastatic NSCLC. Current clinical evidence supports LAT alone or in combination with systemic therapies. Our retrospective mono-institutional study aims to assess the role of LAT with a peculiar focus on the largest series of non-oncogene addicted oligometastatic NSCLC patients to date. We included in this analysis all patients with the mentioned disease characteristics who underwent LAT for intracranial and/or extracranial metastases between 2011 and 2020. The main endpoints were local control (LC), progression free survival (PFS) and overall survival (OS) in the whole population and after stratification for prognostic factors. We identified a series of 245 consecutive patients (314 lesions), included in this analysis (median age 69 years). In 77% of patients, a single metastasis was treated with LAT and intracranial involvement was the most frequent indication (53% of patients) in our series. The overall response rate (ORR) after LAT was 95%. In case of disease progression, 66 patients underwent new local treatments with curative intent. With a median follow-up of 18 months, median PFS was 13 months (1-year PFS 50%) and median OS was 32 months (1-year OS 75%). The median LC was not reached (1-year LC 89%). The presence of brain metastases was the only factor that negatively affected all clinical endpoints, with a 1-year LC, PFS and OS of 82%, 29% and 62% respectively, compared to 95%, 73% and 91%, respectively, for patients without BMs (p < 0.001 for each endpoint). At the multivariate analysis, mediastinal nodal involvement at baseline (p = 0.049), ECOG PS = 1 (p = 0.011), intracranial disease involvement (p = 0.001), administration of chemotherapy in combination with LAT (p = 0.020), and no delivery of further local treatment for progression or delivery of focal treatment for intracranial progression (p < 0.001) were related to a poorer OS. In our retrospective series, which is to our knowledge the largest to date, LAT showed encouraging results and confirmed the safety and effectiveness of focal treatments in non-oncogene addicted oligometastatic NSCLC patients.

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Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

Cited by 36 publications

References 158 publications

Prognostic Significance of Galectin-1 but Not Galectin-3 in Patients With Lung Adenocarcinoma After Radiation Therapy

Prognostic Significance of Galectin-1 but Not Galectin-3 in Patients With Lung Adenocarcinoma After Radiation Therapy

Management Strategies for Large Brain Metastases

Role of Radiosurgery and Stereotactic Ablative Radiotherapy for Oligometastatic Non-Oncogene Addicted NSCLC

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