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Volume 10
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Review

A Review of the Role of Stereotactic Radiosurgery and Immunotherapy in the Management of Primary Central Nervous System Tumors

by
Eric J. Lehrer
1,*,
Brianna M. Jones
1,
Kunal K. Sindhu
1,
Daniel R. Dickstein
1,
Mira Cohen
1,
Stanislav Lazarev
1,
Alfredo Quiñones-Hinojosa
2,
Sheryl Green
1 and
Daniel M. Trifiletti
3
1
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
2
Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, USA
3
Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
*
Author to whom correspondence should be addressed.
Biomedicines 2022, 10(11), 2977; https://doi.org/10.3390/biomedicines10112977
Submission received: 28 October 2022 / Revised: 15 November 2022 / Accepted: 15 November 2022 / Published: 19 November 2022
(This article belongs to the Special Issue The Synergy of Radiotherapy and Immunotherapy)
Versions Notes

Abstract

Stereotactic radiosurgery (SRS) and immune checkpoint inhibitors (ICIs) are widely used in the management of brain metastases. These therapies are commonly administered concurrently; as SRS may enhance anti-tumor immunity and responsiveness to ICIs. However, the use of ICIs with and without SRS in the management of primary brain tumors remains a controversial topic. Meningiomas are the most common nonmalignant and extra-parenchymal brain tumor, which often respond well to surgery and radiotherapy. However, higher grade meningiomas tend to be resistant to these treatments, and the use of chemotherapy and targeted agents in this setting have yielded disappointing results. Thus, there is heightened interest in the utilization of ICIs. Glioblastoma is the most common malignant primary intraparenchymal brain tumor. It is associated with a grim prognosis with a median overall survival of approximately 20 months, despite optimal therapy. While SRS in the adjuvant setting, and ICI in the recurrent setting, have failed to demonstrate a survival benefit, SRS in the preoperative setting has the potential to enhance anti-tumor immunity and responsiveness to ICIs. Thus, these treatments represent an attractive option to add to the armamentarium of meningioma and glioblastoma management. In this review, we provide a detailed overview of the evidence supporting the use of ICIs and SRS in each of these settings.
Keywords: stereotactic radiosurgery; immunotherapy; neurosurgery; radiation oncology; glioma; meningioma; glioblastoma stereotactic radiosurgery; immunotherapy; neurosurgery; radiation oncology; glioma; meningioma; glioblastoma

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MDPI and ACS Style

Lehrer, E.J.; Jones, B.M.; Sindhu, K.K.; Dickstein, D.R.; Cohen, M.; Lazarev, S.; Quiñones-Hinojosa, A.; Green, S.; Trifiletti, D.M. A Review of the Role of Stereotactic Radiosurgery and Immunotherapy in the Management of Primary Central Nervous System Tumors. Biomedicines 2022, 10, 2977. https://doi.org/10.3390/biomedicines10112977

AMA Style

Lehrer EJ, Jones BM, Sindhu KK, Dickstein DR, Cohen M, Lazarev S, Quiñones-Hinojosa A, Green S, Trifiletti DM. A Review of the Role of Stereotactic Radiosurgery and Immunotherapy in the Management of Primary Central Nervous System Tumors. Biomedicines. 2022; 10(11):2977. https://doi.org/10.3390/biomedicines10112977

Chicago/Turabian Style

Lehrer, Eric J., Brianna M. Jones, Kunal K. Sindhu, Daniel R. Dickstein, Mira Cohen, Stanislav Lazarev, Alfredo Quiñones-Hinojosa, Sheryl Green, and Daniel M. Trifiletti. 2022. "A Review of the Role of Stereotactic Radiosurgery and Immunotherapy in the Management of Primary Central Nervous System Tumors" Biomedicines 10, no. 11: 2977. https://doi.org/10.3390/biomedicines10112977

APA Style

Lehrer, E. J., Jones, B. M., Sindhu, K. K., Dickstein, D. R., Cohen, M., Lazarev, S., Quiñones-Hinojosa, A., Green, S., & Trifiletti, D. M. (2022). A Review of the Role of Stereotactic Radiosurgery and Immunotherapy in the Management of Primary Central Nervous System Tumors. Biomedicines, 10(11), 2977. https://doi.org/10.3390/biomedicines10112977

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