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Mudra et al. J Cancer Metastasis Treat 2019;5:27 Journal of Cancer
DOI: 10.20517/2394-4722.2019.09 Metastasis and Treatment

Review Open Access

Stereotactic radiosurgery in the era of novel
systemic therapy for lung cancer brain metastases

Sarah Mudra , Shruti Bhandari , Prashant Tripathi , Neal Dunlap , Goetz Kloecker 2
2
1
3
4
1 University of Louisville School of Medicine, Louisville, KY 40202, USA.
2 Department of Internal Medicine, Division of Hematology and Medical Oncology, James Graham Brown Cancer Center,
University of Louisville School of Medicine, Louisville, KY 40202, USA.
3 Division of Infectious Disease, University of Louisville School of Medicine, Louisville, KY 40202, USA.
4 Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville,
KY 40202, USA.
Correspondence to: Dr. Goetz Kloecker, Department of Internal Medicine, Division of Hematology and Medical Oncology, James
Graham Brown Cancer Center, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY 40202, USA.
E-mail: goetz.kloecker@louisville.edu

How to cite this article: Mudra S, Bhandari S, Tripathi P, Dunlap N, Kloecker G. Stereotactic radiosurgery in the era of novel
systemic therapy for lung cancer brain metastases. J Cancer Metastasis Treat 2019;5:27.
http://dx.doi.org/10.20517/2394-4722.2019.09
Received: 15 Jan 2019 First Decision: 6 Feb 2019 Revised: 13 Feb 2019 Accepted: 20 Feb 2019 Published: 3 Apr 2019

Science Editor: Lucyna Kepka Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
The emergence of novel systemic therapies has spurred a dramatic paradigm shift in lung cancer treatment. Research
has revealed greater intracranial efficacy in targeted agents and immune checkpoint inhibitors (ICI) compared to
conventional chemotherapy. Concurrently, advances in stereotactic radiosurgery (SRS) have contributed to the
increased use of this highly localized, minimally-invasive treatment modality for local tumor control. In this era
of precision medicine, the combination of these novel agents and SRS demands further prospective exploration -
particularly as questions regarding their sequence of administration and the risk of neurotoxicity remain unanswered.
Presently, although data are limited and largely retrospective, literature supports the concurrent administration of
ICI and radiation, with no observed increases in immune-related adverse events or acute neurologic toxicities. In
the case of patients with driver mutations, newer generations of tyrosine kinase inhibitors (TKI) display improved
intracranial efficacy and are currently preferred alone upfront in patients with asymptomatic brain metastases (BM)
due to lack of data. Evidence of combining TKI and SRS is limited with mixed results. In this review, we explore the
evidence regarding the use of novel systemic agents and SRS for treatment of lung cancer BM. Clinical practice will
continue to be refined as larger, prospective studies yield results.

Keywords: Lung cancer; stereotactic radiosurgery, brain metastasis, tyrosine kinase inhibitors, immunotherapy

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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