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TheManagementofBrainMetastasisin

LungCancerWithAFocuson

Stereotactic

Radiosurgery

WeiningZhen,M.D.,FACR

Professor

RadiationOncology

Otolaryngology-HeadandNeckSurgery

UniversityofNebraska

CRTOGSymposiumJuly9,2017

Objectives:

Discusstreatmentoptionsforbrainmetastasis:

•WBRTvs.SRS

•Surgeryvs.SRS

•PostoperativeRT

Currentstatusandfuturetrendin

managementofbrainmetastasis

•Incidenceofbrainmetastasiscontinuestorise

•Radiotherapyplaysthemajorroleinthetreatment

•WBRTbecomeslesscommonlyusedasinitialmodality

•Surgeryplaysmorelimitedrole

•SRSisbecomingthemainupfronttreatmentmodality

•Anestimated20-40%ofallcancerpatientswilldevelopBM

•AnnualincidenceofBM200,000intheU.S.

•TheincidenceofBMwilllikelycontinuetoriseas

improvementsin:

üsystemictherapyincreasepatientsurvival

üsensitiveimagingtechniquesaremorewidelyadopted.

Incidenceofbrainmetastasesfrom1986to2006inSweden

Smedby,etal.BrJCancer101:1919-1924,2009

LungCancerandBrainMetastases

•Mostcommonprimarytumortometastasizeto

brain

•18-65%oflungcancerpatientsdevelopbrain

metastases

•RiskofdevelopingCNSdiseasedependent

upontumorcelltype

–SCLC40-50%

–NSCLC

•Largecell/Adenocarcinoma30-40%

•Squamouscell10-15%

•TimeintervalbetweendiagnosisandCNS

diseaseis2-9months.

BrainMetastasesinNSCLC

CNSMetastasesMedian