| Abstract: |
Simple Summary: Brain metastases are common in patients with lung cancer, leading to significant neurological injury and neurologic mortality. Recent research efforts in radiation and systemic therapies have led to significant improvements in clinical outcomes for these patients and have shed light on possible novel combinatorial approaches. Many patients will develop brain metastases while on systemic therapy and it is critical to define how to integrate radiation therapy, the current standard of care, with treatments that have efficacy against brain metastases. Herein, we review the historical context and recent advances in radiation therapy and systemic therapies. We highlight ongoing approaches to integrate multimodal regimens and discuss novel strategies to predict brain metastases to further guide management. Lung cancer, both non-small cell and small cell, harbors a high propensity for spreading to the central nervous system. Radiation therapy remains the backbone of the management of brain metastases. Recent advances in stereotactic radiosurgery have expanded its indications and ongoing studies seek to elucidate optimal fractionation and coordination with systemic therapies, especially targeted inhibitors with intracranial efficacy. Efforts in whole-brain radiotherapy aim to preserve neurocognition and to investigate the need for prophylactic cranial irradiation. As novel combinatorial strategies are tested and prognostic/predictive biomarkers are identified and tested, the management of brain metastases in lung cancer will become increasingly personalized to optimally balance intracranial efficacy with preserving neurocognitive function and patient values. |
