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Kepka. J Cancer Metastasis Treat 2020;6:12 Journal of Cancer
DOI: 10.20517/2394-4722.2020.35 Metastasis and Treatment

Editorial Open Access

Radiotherapy of brain metastases from lung cancer:
evidences and areas of research

Lucyna Kepka

Department of Radiotherapy, Military Institute of Medicine, Warsaw 04-141, Poland.
Correspondence to: Prof. Lucyna Kepka, MD, PhD Department of Radiotherapy, Military Institute of Medicine, Warsaw 04-141,
Poland. E-mail: lkepka@wim.mil.pl

How to cite this article: Kepka L. Radiotherapy of brain metastases from lung cancer: evidences and areas of research. J Cancer
Metastasis Treat 2020;6:12. http://dx.doi.org/10.20517/2394-4722.2020.35

Received: 21 Apr 2020 Accepted: 21 Apr 2020 Published: 11 May 2020

Science Editor: Lucio Miele Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Historically, the standard treatment for brain metastases (BM) from lung cancer involved neurosurgical
resection and radiotherapy. Chemotherapy was applied, to a lesser extent, mainly for small-cell lung
cancer (SCLC). However, with the ever-changing landscape of lung cancer therapy, the approach to the
treatment of BM from lung cancer is also evolving. Generally, there has been a tendency to avoid whole-
brain radiotherapy (WBRT) and to use more focused forms, i.e., stereotactic radiosurgery (SRS). Currently,
in patients with WHO performance status 0-2 having up to 4 BM, local therapy (surgery or SRS) without
[1]
WBRT is recommended . The rationale for such an approach is based on evidence that the omission
of WBRT minimizes neurocognitive toxicity and there is no difference in overall survival between local
[2-4]
therapy (SRS or surgery) only and WBRT . Nevertheless, a substantial proportion of lung cancer patients
have multiple BM and for them, WBRT remains the primary treatment modality, unless their general
performance status is very poor. For such patients with poor performance status, WBRT has no benefit over
[5,6]
the use of steroids alone . The prognosis of patients with BM from lung cancer is considered poor with a
[7,8]
median overall survival of about 4 months with WBRT . However, it was shown that WBRT in NSCLC
patients with BM having EGFR mutations and ALK rearrangement had improved overall survival [9,10] .
Novel therapies such as targeted agents for BM in lung cancer with driver mutations and immune
checkpoint inhibitors have greater intracranial efficacy compared to conventional chemotherapy. In turn,
this also promoted research towards combining these novel agents with SRS or WBRT. While the tumor’s
molecular status may have an impact on the decision to delay WBRT or SRS in subgroups of patients, there
is insufficient data to make more definitive recommendations currently.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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