Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
- identification of patients who would benefit most from the combination of systemic and local brain-targeted radiation therapies;
- management of the potential toxicity when combining SRS with systemic therapies i.e., treatment of radionecrosis;
- limitation of the long-term sequelae of brain radiation in patients with stage IV NSCLC who achieve prolonged survival;
- risk of leptomeningeal or pachymeningeal failure with the increased use of focal brain radiation over WBRT;
- decision for a “watch and wait” approach of asymptomatic BMs when administering systemic drugs that exhibit intracranial activity.
2. Rationale for Combining Brain RT and Systemic Therapies and Putative Pitfalls
3. Combination Strategies Using Radiotherapy
3.1. Chemotherapy
3.2. Targeted Therapies
3.3. Immunotherapy
4. Oligometastatic CNS Disease and “Watch and Wait” of Asymptomatic BMs
5. The Challenge of Recurrence, Radioresistance and Radionecrosis
6. Proton Beam Therapy for the Treatment of NSCLC Brain Metastases
7. Animal Models to Test Novel Therapeutic Approaches
8. Conclusions and Future Perspectives
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Trial Number | Phase | Key Eligibility | Intervention | Status |
---|---|---|---|---|
NCT03535363 | I | EGFR-mutated NSCLC with 1-10 BMs | Osimertinib + SRS | Recruiting |
NCT03497767 | II | EGFR-mutated NSCLC with BMs diagnosed de novo or developed while on first-line EGFR-TKI | Osimertinib alone vs. upfront SRS + osimertinib | Recruiting |
NCT02726568 | II | EGFR-mutated NSCLC with BMs | Icotinib + SRS when intracranial progression | Recruiting |
NCT03769103 | II | Metastatic EGFR-mutated NSCLC with BMs | Osimertinib alone vs. osimertinib + SRS | Recruiting |
NCT04193007 | II | Asymptomatic NSCLC BMs with Gene-Sensitive Mutation | Molecular therapy alone (first-generation EGFR-TKI or ALK inhibitor) vs. molecular targeted therapy + brain radiotherapy (SRS or SMART-brain) | Not yet recruiting |
NCT01573702 | II | EGFR-mutant NSCLC patients who progressed on prior EGFR-TKI therapy | SRS or another local ablation followed by Erlotinib | Active, not recruiting |
Group 1 Indications * | Group 2 Indications ** |
---|---|
Malignant and benign primary CNS tumors * Advanced (e.g., T4) and/or unresectable head and neck cancers * Tumors of the paranasal sinuses and other accessory sinuses * Nonmetastatic retroperitoneal sarcomas * Reirradiation cases where cumulative critical structure dose would exceed tolerance dose * Hepatocellular cancer (no longer required to be treated in a hypofractionated regimen *) Ocular tumors, including intraocular melanomas Tumors that approach or are located at the base of skull, including but not limited to chordoma and chondrosarcomas Primary or metastatic tumors of the spine where the spinal cord tolerance may be exceeded with conventional treatment/where the spinal cord has previously been irradiated Primary or benign solid tumors in children treated with curative intent and occasional palliative treatment of childhood tumors where one of the criteria noted above apply Patients with genetic syndromes to minimize the total volume of radiation, such as but not limited to NF-1 and retinoblastoma patients | Non-T4 and resectable head and neck cancer Prostate cancer Breast cancer Thoracic malignancies Abdominal malignancies, including nonmetastatic primary pancreatic, biliary and adrenal cancers Pelvic malignancies, including nonmetastatic rectal, anal, bladder and cervical cancers |
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Jablonska, P.A.; Bosch-Barrera, J.; Serrano, D.; Valiente, M.; Calvo, A.; Aristu, J. Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer. Cancers 2021, 13, 2141. https://doi.org/10.3390/cancers13092141
Jablonska PA, Bosch-Barrera J, Serrano D, Valiente M, Calvo A, Aristu J. Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer. Cancers. 2021; 13(9):2141. https://doi.org/10.3390/cancers13092141
Chicago/Turabian StyleJablonska, Paola Anna, Joaquim Bosch-Barrera, Diego Serrano, Manuel Valiente, Alfonso Calvo, and Javier Aristu. 2021. "Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer" Cancers 13, no. 9: 2141. https://doi.org/10.3390/cancers13092141