Multimodality management of non-small cell lung cancer patients with brain metastases.

PURPOSE OF REVIEW: Brain metastases are an important cause of morbidity and mortality, and are the most common intracranial tumors in adults. The prognosis of patients with brain metastases is very poor. The increasing incidence of brain metastases is directly related to the improvements in the treatment of systemic disease. Commonly, brain metastases are discovered after the diagnosis of cancer, often after other systemic metastases have developed. In this review article, we present the standard treatment approach and discuss new directions.

RECENT FINDINGS: The most widely used treatment for patients with brain metastases is whole-brain radiotherapy. Actually, surgery and radiotherapy remain the principal therapeutic interventions. In contrast, the benefit of chemotherapy has long been viewed with skepticism.In an effort to improve the therapeutic ratio, radiosensitizers are often used concurrently with external-beam radiation: motexafin gadolinium and efaproxaril.Novel anticancer agents are under clinical investigation.

SUMMARY: The management of patients with brain metastases with non-small cell lung cancer has improved over time, due to the development of new treatment options and a better knowledge of prognostic factors.In the next 5 years, the results of several ongoing multicenter randomized trials will become available to further define the role of various radiation sensitizers and chemotherapeutic agents in combination with stereotactic radiosurgery, whole-brain radiation therapy, or both.