Central Nervous System Metastases In Lung Cancer Patients From Prevention To Diagnosis And Treatment

Approximately 40% of lung cancer patients will develop central nervous system (CNS) metastases during the course of their disease. Most of these are brain metastases, but up to 10% will develop leptomeningeal metastases. Known risk factors for CNS metastases development are small cell lung cancer (SCLC), adenocarcinoma histology, epidermal growth factor receptor (EGFR) mutant or anaplastic lymphoma kinase (ALK) rearranged lung cancer, advanced nodal status, tumor stage and younger age. CNS metastases can have a negative impact on quality of life (QoL) and overall survival (OS). The proportion of lung cancer patients diagnosed with CNS metastases has increased over the years due to increased use of brain imaging as part of initial cancer staging, advances in imaging techniques and better systemic disease control. Post contrast gadolinium enhanced magnetic resonance imaging (gd-MRI) is preferred, however when this is contra-indicated a contrast enhanced computed tomography (CE-CT) is mentioned as an alternative option. When CNS metastases are diagnosed, local treatment options consist of radiotherapy (stereotactic or whole brain) and surgery. Local treatment can be complicated by symptomatic radiation necrosis for which no high level evidence based treatment exists. Moreover, differential diagnosis with metastasis progression is difficult. Systemic treatment options have expanded over the last years. Until recently, chemotherapy was the only treatment option with a poor penetration in the CNS. Angiogenesis inhibitors are promising in the treatment of primary CNS tumors as well as radiation necrosis but clinical trials of anti-angiogenic agents in NSCLC have largely excluded patients with CNS metastases. Furthermore, research has also focused on methods to prevent development of CNS disease, for example with prophylactic cranial irradiation. Recently, checkpoint inhibitors have become available for NSCLC patients, and tyrosine kinase inhibitors (TKIs) have improved prognosis significantly in those with a druggable driver mutation. Newer TKIs are often designed to have better CNS penetration compared to first-generation TKIs. Despite advances in treatment options CNS metastases remain a problem in lung cancer and cause morbidity and mortality. This Research Topic provides an extensive resource of articles describing advances in CNS metastases management in lung cancer patients, from prevention to diagnosis and treatment.

Approximately 40% of lung cancer patients will develop central nervous system (CNS) metastases during the course of their disease. Most of these are brain metastases, but up to 10% will develop leptomeningeal metastases. Known risk factors for CNS metastases development are small cell lung cancer (SCLC), adenocarcinoma histology, epidermal growth factor receptor (EGFR) mutant or anaplastic lymphoma kinase (ALK) rearranged lung cancer, advanced nodal status, tumor stage and younger age. CNS metastases can have a negative impact on quality of life (QoL) and overall survival (OS). The proportion of lung cancer patients diagnosed with CNS metastases has increased over the years due to increased use of brain imaging as part of initial cancer staging, advances in imaging techniques and better systemic disease control. Post contrast gadolinium enhanced magnetic resonance imaging (gd-MRI) is preferred, however when this is contra-indicated a contrast enhanced computed tomography (CE-CT) is mentioned as an alternative option. When CNS metastases are diagnosed, local treatment options consist of radiotherapy (stereotactic or whole brain) and surgery. Local treatment can be complicated by symptomatic radiation necrosis for which no high level evidence based treatment exists. Moreover, differential diagnosis with metastasis progression is difficult. Systemic treatment options have expanded over the last years. Until recently, chemotherapy was the only treatment option with a poor penetration in the CNS. Angiogenesis inhibitors are promising in the treatment of primary CNS tumors as well as radiation necrosis but clinical trials of anti-angiogenic agents in NSCLC have largely excluded patients with CNS metastases. Furthermore, research has also focused on methods to prevent development of CNS disease, for example with prophylactic cranial irradiation. Recently, checkpoint inhibitors have become available for NSCLC patients, and tyrosine kinase inhibitors (TKIs) have improved prognosis significantly in those with a druggable driver mutation. Newer TKIs are often designed to have better CNS penetration compared to first-generation TKIs. Despite advances in treatment options CNS metastases remain a problem in lung cancer and cause morbidity and mortality. This Research Topic provides an extensive resource of articles describing advances in CNS metastases management in lung cancer patients, from prevention to diagnosis and treatment.

This book provides a comprehensive overview of brain metastases, from the molecular biology aspects to therapeutic management and perspectives. Due to the increasing incidence of these tumors and the urgent need to effectively control brain metastatic diseases in these patients, new therapeutic strategies have emerged in recent years. The volume discusses all these innovative approaches combined with new surgical techniques (fluorescence, functional mapping, integrated navigation), novel radiation therapy techniques (stereotactic radiosurgery) and new systemic treatment approaches such as targeted- and immunotherapy. These combination strategies represent a new therapeutic model in brain metastatic patients in which each medical practitioner (neurosurgeon, neurologist, medical oncologist, radiation oncologist) plays a pivotal role in defining the optimal treatment in a multidisciplinary approach. Written by recognized experts in the field, this book is a valuable tool for neurosurgeons, neuro-oncologists, neuroradiologists, medical oncologists, radiation oncologists, cognitive therapists, basic scientists and students working in the area of brain tumors.

This is a multi-specialty book on the diagnosis, evaluation, and treatment of CNS metastases of the brain and spine. Written by renowned experts in their fields, the book covers essential contemporary topics in CNS metastases care. The book is divided into seven parts that begin with chapters that cover the fundamental biology of disease so that subsequent chapters on imaging, diagnosis, treatment, and palliation can be properly contextualized. This text also provides a framework for understanding the biology of radiation therapy so that radiation treatment options of the brain and spine can be more fully understood. New medications and technologies are reviewed from the perspective of maximizing efficacy and minimizing toxicity, independently and as combinatorial therapy. Central Nervous System Metastases: Diagnosis and Treatment serves as a practical reference for health care providers and trainees. It provides the comprehensive, detailed perspective required to provide holistic care to patients with metastatic disease to the brain and spine.

This issue of Neurosurgery Clinics, guest edited by Drs. Edjah Nduom and Jeff Olson, will focus on Metastases to the Central Nervous System. This issue is one of four selected each year by our series consulting editors, Dr. Russell R. Lonser and Dr. Daniel K. Resnick. Topics discussed in this issue will include: Epidemiology of metastatic CNS disease, Initial approach to the patient with a newly diagnosed solitary brain metastasis, Initial approach to the patient with multiple newly diagnosed brain metastases, When to consider a stereotactic biopsy for brain metastases, Techniques for open surgical resection of cerebral metastases, Laser ablation for cerebral metastases, Histopathological features and laboratory markers of common brain metastases, Recurrence vs radiation necrosis – evaluation and treatment, Anti-epileptic drugs for the management of cerebral metastases, Chemotherapy for the management of cerebral metastases, Approach to the management of metastatic leptomeningeal disease, Immune therapy for CNS metastases, Novel therapeutic targets for the treatment of cerebral metastases, Skull base metastases – diagnosis and management, and more.

This is a multi-specialty book on the diagnosis, evaluation, and treatment of CNS metastases of the brain and spine. Written by renowned experts in their fields, the book covers essential contemporary topics in CNS metastases care. The book is divided into seven parts that begin with chapters that cover the fundamental biology of disease so that subsequent chapters on imaging, diagnosis, treatment, and palliation can be properly contextualized. This text also provides a framework for understanding the biology of radiation therapy so that radiation treatment options of the brain and spine can be more fully understood. New medications and technologies are reviewed from the perspective of maximizing efficacy and minimizing toxicity, independently and as combinatorial therapy. Central Nervous System Metastases: Diagnosis and Treatment serves as a practical reference for health care providers and trainees. It provides the comprehensive, detailed perspective required to provide holistic care to patients with metastatic disease to the brain and spine.

Brain metastases are the most dreaded complication of systemic cancer, affecting some 170,000 people a year, a far greater incidence than primary brain tumors. This book presents current information on the presentation and management of patients with brain metastases, providing available data, giving guidelines that can be applied in day to day practice, updated information for neurosurgeons, radiation oncologists, medical oncologists, and neuron-oncologists, and as an overview for physicians in training.