Radiosurgery and radiotherapy for non-small-cell lung cancer metastatic to brain

Non-small-cell lung cancer metastatic to brain represents a common problem in oncology. Treatment modalities include stereotactic radiosurgery (SRS), whole-brain radiotherapy (WBRT), surgical resection, supportive care, or a combination of these options. This review outlines therapeutic strategies for treatment with particular attention to the use of SRS. Radiosurgical technique, radiobiology, dose prescription, patient selection, and results of therapy are discussed. The term SRS describes a radiation procedure that utilizes a three-dimensional stereotactic localization system to precisely treat small intracranial targets with a single, large, highly focal radiation dose. Stereotactic radiosurgery is appealing for several reasons; it is minimally invasive, easily tolerated, and highly effective, and patients return to normal baseline function within 24 hours. Stereotactic radiosurgery provides much higher control rates of treated lesions than does WBRT. Randomized trials are underway to ascertain the optimal role and timing of SRS in relation to WBRT in order to maximize control, survival, quality of life, and neuropsychological outcome.