Current Treatment Options in Oncology

, Volume 14, Issue 4, pp 553–567 | Cite as

Treatment of Brain Metastases in Lung Cancer: Strategies to Avoid/Reduce Late Complications of Whole Brain Radiation Therapy

  • Mark G. ShawEmail author
  • David L. Ball
Lung Cancer (HA Wakelee, Section Editor)

Opinion statement

Brain metastases occur in 20-40 % of lung cancer patients. The use of whole brain radiation therapy (WBRT) has been shown to ameliorate many neurological symptoms, facilitate corticosteroid reduction, enhance quality of life (QOL), and prolong survival. The acute and early delayed side effects of WBRT are generally mild and inconsequential, whereas late complications often are progressive, irreversible, and may have a profound effect on neurocognitive function and QOL. Nevertheless, WBRT remains the cornerstone for treatment of multiple brain metastases due to its efficacy and the paucity of other treatment options. In avoidance of WBRT and its potential toxicity, patients of good performance status and ≤3 metastases may be treated reasonably with focal therapy alone (surgery or radiosurgery) without a compromise in survival. In patients with multiple brain metastases and those undergoing prophylactic cranial irradiation (PCI), established methods to mitigate the late complications of WBRT include total dose observation, dose per fraction restrictions, and avoidance of concomitant chemotherapy. Current areas of active research that hold great potential for benefit include hippocampal-sparing radiotherapy and the use of neuroprotective agents.


Whole brain radiation therapy Brain metastases Neurocognitive impairment Quality of life Neuroprotection Hippocampus 


Conflict of Interest

Mark G. Shaw declares that he has no conflict of interest.

David L. Ball has board membership with Boehringer-Ingelheim, Pfizer, and Lilly Oncology and received payment for the development of educational presentations from Lilly Oncology and Pfizer.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Radiation OncologyPeter MacCallum Cancer CentreEast MelbourneAustralia

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