Treatment of brain metastases from non-small-cell lung cancer (NSCLC): radiotherapy

Brain metastases occur frequently in tung-cancer patients and are associated with a crucial decrease in prognosis and impairment of life quality. With improved treatment and earlier diagnosis of primary tumour as well as earlier detection of lesions due to improved neuroradiological diagnosis the incidence is apparently increasing. Whole-brain radiation therapy (WBRT) prolongs median survival from 1 to 3-6 months. One-year survival rate after WBRT is approximately 10-20%. Neurological function could be improved with minimal morbidity. However, long-term survival is observed in patients with favourable prognostic factors like controlled primary tumour site, no extracranial disease, good performance status and age <60 years. In these patients individually optimised aggressive treatment strategies are clearly justified. Surgical resection or radiosurgery (RS) combined with adjuvant WBRT prolong survival to similar to8-11 months. Surgical resection is preferred when rapid relief of increased intracranial pressure is required. The incidence of new brain metastases is low in patients with poor prognostic factors. Palliative RS could be used in these patients to rapidly improve neurological deficits. In locally advanced NSCLC radiosurgery may be used to effectively control brain disease without delay in treatment of the primary tumour site. The role of prophylactic ("elective") cranial. irradiation in NSCLC patients as well as the role of combined radiochemotherapy for brain metastases has to be addressed in further clinical trials in the future. (C) 2004 Elsevier Science Ltd.