Treatment of brain metastases

Patients who present with a solitary cerebral metastasis after resection of a primary NSCLC lesion and who have no evidence of extracranial tumor can achieve prolonged disease-free survival with surgical excision of the brain metastasis and postoperative whole-brain radiation therapy.[114,115] Unresectable brain metastases in this setting may be treated with stereotactic radiosurgery.[116]

Approximately 50% of patients treated with resection and postoperative radiation therapy will develop recurrence in the brain; some of these patients will be suitable for additional treatment.[117] In those selected patients with good performance status and without progressive metastases outside of the brain, treatment options include reoperation or stereotactic radiation surgery.[116,117] For most patients, additional radiation therapy can be considered; however, the palliative benefit of this treatment is limited.[118][Level of evidence C2]