Thoracic Malignancies

Brain Metastases

Questions discussed in this category

Is it acceptable to treat patients with limited, asymptomatic brain metastases and EGFR-mutant NSCLC with upfront TKI?

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

9 Answers available

How do you manage anticoagulation for patients with DVT/PE who have brain metastases?

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage. Is there a...

4 Answers available

Would you consider delaying tarlatamab initiation in a patient with ES SCLC who recently completed RT for CNS disease, given the concern for immune effector cell-associated neurotoxicity syndrome (ICANS)?

5 Answers available

In ES-SCLC presenting with extensive brain metastases, how do you time whole brain radiation after the first cycle of chemotherapy has already been delivered?

1 Answer available

Aside from radiation, what is your approach to patients with EGFR-mutated or ALK-translocated metastatic NSCLC who have systemic disease control but fail in the CNS?

Do you increase the dosage of the TKI or switch to a different generation TKI? How does your answer differ for EGFR vs. ALK, and for discrete brain me...

2 Answers available

What would be your approach in a patient who presented with a solitary brain metastasis that resolved after chemo without local therapy?

Would you offer consolidative brain SRS, SRS + consolidative RT to the primary (e.g. lung), consolidative RT to the primary alone?

2 Answers available

Is it acceptable to treat newly diagnosed small cell lung cancer with limited brain metastasis with upfront SRS?

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

12 Answers available

Do you recommend holding a TKI when treating brain metastases with SRS/WBRT?

Is there evidence that supports/refutes the safety of concurrent use?

1 Answer available

Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?

7 Answers available

What is the best treatment dose and fractionation for WBRT in a patient who has numerous brain mets and previously received PCI with 25Gy/10fx for small cell lung cancer?

1 Answer available

Would you offer systemic therapy after rendered NED from SRS to isolated CNS metastases in a patient with prior curative intent treatment of lung adenocarcinoma and clear cell RCC?

0 Answers available

Would you continue immune checkpoint inhibitor therapy in a metastatic NSCLC patient with CNS failure if the systemic disease is otherwise controlled?

Does the extent/duration of systemic disease control (complete response vs. stable disease, for example) influence your decision? What about whe...

1 Answer available

Papers discussed in this category

Clinical oncology (Royal College of Radiologists (Great Britain)), 2007-09

Value of whole brain re-irradiation for brain metastases--single centre experience.

Radiation oncology (London, England), 2014-01-03

Re-irradiation in the treatment of patients with cerebral metastases of solid tumors: retrospective analysis.

N Engl J Med, 2007 Aug 16

Prophylactic cranial irradiation in extensive small-cell lung cancer.

J Clin Oncol, 1999 Jul

Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: A randomized study.

Lancet, 2015 Jan 3

Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial.

International journal of radiation oncology, biology, physics, 2011-11-01

Stereotactic radiosurgery for patients with brain metastases from small cell lung cancer.

Int. J. Radiat. Oncol. Biol. Phys., 2006-09-01

A pathology-based substrate for target definition in radiosurgery of brain metastases.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2017-12

Prophylactic Cranial Irradiation (PCI) versus Active MRI Surveillance for Small Cell Lung Cancer: The Case for Equipoise.

Lancet Oncol., 2017-05-01

Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial.

The New England journal of medicine, 1999-08-12

Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group.

BMC Cancer, 2015-08-15

Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer.

Journal of cancer research and therapeutics, 2012

Clinical outcomes of reirradiation of brain metastases from small cell lung cancer with Cyberknife stereotactic radiosurgery.

International journal of radiation oncology, biology, physics, 2012-05-01

Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer.

Neurosurgery, 2013-10

Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery.

Practical radiation oncology, 2015

Local recurrence and survival following stereotactic radiosurgery for brain metastases from small cell lung cancer.

J. Neurosurg., 2005-01-01

Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors.

J Korean Neurosurg Soc, 2011-08-01

The role of radiosurgery in patients with brain metastasis from small cell lung carcinoma.

Radiat Oncol, 2014-07-08

Upfront stereotactic radiosurgery in patients with brain metastases from small cell lung cancer: retrospective analysis of 41 patients.

BMC Cancer, 2015-03-04

Is stereotactic radiosurgery a rational treatment option for brain metastases from small cell lung cancer? A retrospective analysis of 70 consecutive patients.

Acta Neurochir (Wien), 2013-01-01

Efficacy and limitations of salvage gamma knife radiosurgery for brain metastases of small-cell lung cancer after whole-brain radiotherapy.

The Lancet. Oncology, 2009-11

Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-04-01

Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function.

J Clin Oncol, 2011 Jan 10

Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study.

JAMA, 2016-07-26

Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial.

Radiation oncology (London, England), 2014-09-30

Stereotactic radiosurgery alone for small cell lung cancer: a neurocognitive benefit?

Cancer, 2016-06-15

Risk of brain metastases in patients with nonmetastatic lung cancer: Analysis of the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) data.

J. Clin. Oncol., 2018 May 22

Prophylactic Cranial Irradiation Versus Observation in Radically Treated Stage III Non-Small-Cell Lung Cancer: A Randomized Phase III NVALT-11/DLCRG-02 Study.

Lung cancer (Amsterdam, Netherlands), 2018-06

Radiosurgery alone is associated with favorable outcomes for brain metastases from small-cell lung cancer.

The New England journal of medicine, 2018-08-23

Combined Nivolumab and Ipilimumab in Melanoma Metastatic to the Brain.

The New England journal of medicine, 2018-12-06

First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer.

International journal of radiation oncology, biology, physics, 2019-04-01

Observe the Brain and Preserve the Mind.

Lancet, 2019 Oct 04

Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial.

JAMA oncology, 2019-06-01

Prophylactic Cranial Irradiation vs Observation in Patients With Locally Advanced Non-Small Cell Lung Cancer: A Long-term Update of the NRG Oncology/RTOG 0214 Phase 3 Randomized Clinical Trial.

International journal of radiation oncology, biology, physics, 2019-04-01

A Gray Zone Regarding Gray Matter.

International journal of radiation oncology, biology, physics, 2019-04-01

Small Cell Lung Cancer: PCI Uncertainty and Emerging Radiosurgery Interest.

Neurosurgery, 2019 Oct 10

Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF).

JAMA Oncol, 2020 Jun 4

Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases: The FIRE-SCLC Cohort Study.

J Clin Oncol, 2020 Aug 10

Radiosurgery for Small-Cell Brain Metastases: Challenging the Last Bastion of Preferential Whole-Brain Radiotherapy Delivery.

Lung Cancer, 2014 Aug 02

Metastatic sites and survival in lung cancer.

N Engl J Med,

The Effect of Advances in Lung-Cancer Treatment on Population Mortality.

Lancet Oncol, 2020 Apr 03

Pembrolizumab for management of patients with NSCLC and brain metastases: long-term results and biomarker analysis from a non-randomised, open-label, phase 2 trial.

Int J Radiat Oncol Biol Phys,

Neurocognitive outcome in brain metastases patients treated with accelerated-fractionation vs. accelerated-hyperfractionated radiotherapy: an analysis from Radiation Therapy Oncology Group Study 91-04.

JAMA,

Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.

J Neurosurg,

Gamma knife radiosurgery for metastatic brain tumors from lung cancer: a comparison between small cell and non-small cell carcinoma.

Cancer,

Leptomeningeal metastases from small cell lung carcinoma.

Radiat Oncol, 2015 May 27

Radiotherapy for asymptomatic brain metastasis in epidermal growth factor receptor mutant non-small cell lung cancer without prior tyrosine kinase inhibitors treatment: a retrospective clinical study.

International journal of radiation oncology, biology, physics, 2016-06-01

Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-04-01

Management of Brain Metastases in Tyrosine Kinase Inhibitor-Naïve Epidermal Growth Factor Receptor-Mutant Non-Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis.

The New England journal of medicine, 2016-11-10

Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer.

The New England journal of medicine, 2018-01-11

Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer.

N. Engl. J. Med.,

Osimertinib in EGFR Mutation–Positive Advanced NSCLC.

Lancet (London, England), 2004-05-22

Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.

J Thorac Oncol, 2021 Aug 26

Brain Metastases in EGFR- and ALK-Positive NSCLC: Outcomes of Central Nervous System-Penetrant Tyrosine Kinase Inhibitors Alone Versus in Combination With Radiation.

Pract Radiat Oncol, 2022 May 6

Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline.

N Engl J Med,

A randomized trial of surgery in the treatment of single metastases to the brain.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2019 Dec 05

Brain metastases from non-small cell lung cancer with EGFR or ALK mutations: A systematic review and meta-analysis of multidisciplinary approaches.

Lung Cancer, 2023 Apr

CNS Downstaging: An Emerging Treatment Paradigm for Extensive Brain Metastases in Oncogene-Addicted Lung Cancer.

J Clin Oncol, 2024 Jul 24

Tyrosine Kinase Inhibitors With and Without Up-Front Stereotactic Radiosurgery for Brain Metastases From EGFR and ALK Oncogene-Driven Non-Small Cell Lung Cancer (TURBO-NSCLC).

BMC cancer, 2023 Oct 30

First-line treatment with TKI plus brain radiotherapy versus TKI alone in EGFR-mutated non-small cell Lung cancer with brain metastases: a systematic review and meta-analysis.

JAMA oncology, 2025 Apr 03

Management of EGFR-Variant and ALK-Positive Non-Small Cell Lung Cancer Brain Metastasis.

Lung cancer (Amsterdam, Netherlands), 2024 Mar 24

Osimertinib plus local treatment for brain metastases versus osimertinib alone in patients with EGFR-Mutant Non-Small Cell Lung Cancer.

Blood, 2015-07-23

Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Apr 19

Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline Update.

Cancer, 2024 Jan 30

Practical guidance for direct oral anticoagulant use in the treatment of venous thromboembolism in primary and metastatic brain tumor patients.

Haematologica, 2025 Feb 06

Multinational cohort study of intracranial hemorrhage in patients with brain metastases receiving anticoagulation.

Hematology. American Society of Hematology. Education Program, 2024 Dec 06

Management of anticoagulation in patients with brain metastasis.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2024 Jun 03

Phase II Efficacy and Safety of 80 mg Osimertinib in Patients With Leptomeningeal Metastases Associated With Epidermal Growth Factor Receptor Mutation-Positive Non-Small Cell Lung Cancer (BLOSSOM).

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2021 May 11

Efficacy and Safety of Intrathecal Pemetrexed Combined With Dexamethasone for Treating Tyrosine Kinase Inhibitor-Failed Leptomeningeal Metastases From EGFR-Mutant NSCLC-a Prospective, Open-Label, Single-Arm Phase 1/2 Clinical Trial (Unique Identifier: ChiCTR1800016615).

International journal of radiation oncology, biology, physics, 2016-06-01

Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG).

Radiat Oncol, 2011-12-21

Radiotherapy and "new" drugs-new side effects?

J Thorac Oncol, 2016 Oct 07

Prophylactic Cranial Irradiation for Patients with Surgically Resected Small Cell Lung Cancer.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-04-01

Role of Adjuvant Therapy in a Population-Based Cohort of Patients With Early-Stage Small-Cell Lung Cancer.

J. Natl. Cancer Inst.,

Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2017-10

Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation.

Advances in radiation oncology, 2017

Factors influencing the utilization of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer.

Journal of the National Comprehensive Cancer Network : JNCCN, 2018-10

NCCN Guidelines Insights: Small Cell Lung Cancer, Version 2.2018.

Pract Radiat Oncol, 2020 May - Jun

Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline.

J Clin Oncol, 2021 Jan 27

Radiation Therapy for Small-Cell Lung Cancer: ASCO Guideline Endorsement of an ASTRO Guideline.

Cancer, 2010 Aug 27

Utilization of prophylactic cranial irradiation in patients with limited stage small cell lung carcinoma.

Journal of geriatric oncology, 2019-07

Survival outcomes after whole brain radiotherapy for brain metastases in older adults with newly diagnosed metastatic small cell carcinoma: A national cancer database (NCDB) analysis.

Chinese journal of cancer research = Chung-kuo yen cheng yen chiu, 2020 Aug

Integration of stereotactic radiosurgery or whole brain radiation therapy with immunotherapy for treatment of brain metastases.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2024 Aug 29

Sustained Clinical Benefit and Intracranial Activity of Tarlatamab in Previously Treated Small Cell Lung Cancer: DeLLphi-300 Trial Update.

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