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Radiation Therapy for Brain Metastases

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Advances in Radiation Oncology in Lung Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Lung cancer is the most common primary tumor in patients with brain metastases. Traditional treatment for multiple (>3–4) lesions includes whole-brain radiotherapy (WBRT) plus dexamethasone. When selecting a WBRT-program, the patient’s survival prognosis should be considered. For single lesions, WBRT + resection produces better outcomes than WBRT or resection alone. Results improve with a boost to the metastatic site. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy appear less invasive alternatives. In patients with few lesions, randomized trials demonstrated that addition of WBRT to SRS improved local/intracranial control but not OS and increased cognitive decline. However, hippocampus-sparing and memantine, which reduce cognitive decline, were not used. In secondary analyses of randomized trials (lung cancer patients only), WBRT improved OS in patients with favorable prognoses. Radiosensitizers and classic chemotherapies have not improved outcomes of WBRT. Tyrosine kinase inhibitors and immune checkpoint inhibitors (ICIs) improve intracerebral response in lung cancer patients irradiated for brain metastases; however, results regarding OS are conflicting. After introduction of ICIs and increasing availability of routine MRI-surveillance, the role of PCI needs to be re-defined. Considering availability of modern radiation techniques and rapid development of targeted therapies, additional trials are warranted for treatment of brain metastases from lung cancer.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany

    Dirk Rades

  2. Department of Pulmonology, University of Lübeck, Lübeck, Germany

    Sabine Bohnet

  3. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA

    Steven E. Schild

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  1. Dirk Rades
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  2. Sabine Bohnet
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  3. Steven E. Schild
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Correspondence to Dirk Rades .

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Editors and Affiliations

  1. School of Medicine, University of Kragujevac, Kragujevac, Serbia

    Branislav Jeremić

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Rades, D., Bohnet, S., Schild, S.E. (2022). Radiation Therapy for Brain Metastases. In: Jeremić, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2021_280

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  • DOI: https://doi.org/10.1007/174_2021_280

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