Thoracic Malignancies

Neuro-Oncology

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

How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?

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

Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?

Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...

1 Answer available

What are your recommendations for a patient with metastatic non-mutated lung adenocarcinoma who previously had headaches responsive to prednisone but with negative temporal artery biopsy for GCA?

For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...

1 Answer 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

Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?

2 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

How would you approach a symptomatic patient with with a history of whole brain RT with new bilateral MRI enhancing lesions within the optic nerves?

Would you suspect progressive disease v. radiation necrosis vs optic neuritis due to immunotherapy. Eyes were within radiation field 8 months ago.&nbs...

1 Answer available

Would you deliver SRS/XRT for isolated asymptomatic CNS metastasis before start of immunotherapy for stage IV lung cancer (negative for driver mutation) with high positive PDL1?

1 Answer available

How would you treat a patient with recurrent brain mets from small cell lung cancer who has already received previous whole brain radiotherapy (30 Gy in 10fx)?

Is there a size or number of metastasis cut-off where you would consider SRS vs. WBRT?

2 Answers available

Do you place any constraint on Dmax when developing plans for linac-based SRS or SBRT?

3 Answers available

Do you do neurocognitive testing before giving PCI or any time thereafter?

Would the results effect your decision to offer PCI?

1 Answer available

Do you offer memantine for patients undergoing PCI?

3 Answers available

When do you consider using ALK targeted systemic therapy in lieu of WBRT or SRS for patients with metastatic ALK-positive NSCLC?

The Phase III J-ALEX study and two phase II studies seem to suggest favorable intracranial response rates for alectinib.

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.

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. Clin. Oncol., 2020 Feb 14

Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001.

J Thorac Oncol, 2021 Feb 02

Phase 3 Randomized Trial of Prophylactic Cranial Irradiation With or Without Hippocampus Avoidance in SCLC (NCT01780675).

Neuro Oncol,

Hippocampal avoidance whole-brain radiotherapy without memantine in preserving neurocognitive function for brain metastases: a phase II blinded randomized trial.

J Clin Oncol, 2021 Aug 11

Randomized Phase III Trial of Prophylactic Cranial Irradiation With or Without Hippocampal Avoidance for Small-Cell Lung Cancer (PREMER): A GICOR-GOECP-SEOR Study.

J Clin Oncol, 2021 Aug 11

Hippocampal Avoidance Prophylactic Cranial Irradiation: A New Standard of Care?

International journal of radiation oncology, biology, physics, 2018-03-15

Concurrent Immune Checkpoint Inhibitors and Stereotactic Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer, Melanoma, and Renal Cell Carcinoma.

J Thorac Oncol, 2019 Feb 16

Outcome of Patients with Non-Small Cell Lung Cancer and Brain Metastases Treated with Checkpoint Inhibitors.

Related Topics in Thoracic Malignancies