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Treatment of Lung Cancer That Has Spread to the Brain

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Updated August 20, 2014

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Treatment of Lung Cancer That Has Spread to the Brain

The treatment of lung cancer that has spread to the brain depends upon how extensive the spread is (for example, how many spots of cancer are present in the brain), your overall health, and the progression of your cancer. Since the goal of treatment is not to cure the cancer, therapy should be chosen with consideration of quality of life in mind foremost. The risks and benefits of the different treatment options should be discussed carefully with your oncologist, taking into account your individual situation and preferences.

The first goal of treatment is to control any complications of brain metastases. Steroids, such as decadron, may be used to control swelling in the brain. If seizures are present, anti-seizure medications may be used. Pain medications may be used to control headaches. Choices for specific treatment may then include:

  • Whole-Brain Radiotherapy: This is usually the treatment of choice if there are tumors that can’t be seen or if more than three tumors are present. Whole-brain radiotherapy may also be used to lower the risk of brain metastases after other treatments, such as surgery. While not meant to cure cancer, at least 50% of people notice some improvement in their symptoms with whole-brain radiotherapy. Common side effects can include memory loss (especially verbal memory), skin rash, and fatigue.

  • Stereotactic Radiotherapy (Stereotactic Radiosurgery): This is not actually surgery, but rather a form of radiation in which a higher dose of radiation is given to a specific area of the brain. Since the radiation is delivered to only a specific region, side effects may be less severe than with whole-brain radiotherapy. Names that you may be familiar with for stereotactic radiotherapy include Gamma Knife or Cyberknife. Stereotactic radiotherapy is usually reserved for people who have three or fewer tumors present in their brain, and in this setting, may improve survival more than whole-brain radiation alone.

  • Surgery: Surgery is occasionally performed to remove lung cancer that has spread to the brain if only a single tumor (or possibly more) is present, the tumor can be easily reached, and if there are no signs of cancer spread in other parts of the body. In this setting, surgery may be done to remove the tumor, or to reduce the size (debulk) the tumor to relieve symptoms. When surgery is performed, it is usually followed up with whole-brain radiation to improve the outcome. Surgery is done more often for non-small cell lung cancers, since small cell lung cancers are usually more sensitive to radiation.

  • Chemotherapy: Due to the "blood-brain barrier," a tight layer of cells that keeps poisons from entering the brain, chemotherapy has not been found to be very effective for brain metastases from lung cancer. That said, several medications, including radiosensitizers (medications that can make cancer cells more susceptible to radiation treatments), are currently being evaluated in clinical trials to assess their effect on brain metastases.

  • Comfort Care: Even when specific therapy is not felt to be helpful, there are still many things that can be done to ease the symptoms of lung cancer that has spread to the brain. Pain medications may help with headaches. Physical and/or occupational therapy may be used to maximize functioning and independence. In addition, many cancer centers are now incorporating complementary treatments, such as massage and acupuncture, to help people cope with the anxiety and other symptoms related to brain metastases.

Prognosis of Lung Cancer that Has Spread to the Brain

Sadly, those who have been diagnosed with lung cancer metastatic to the brain have a median survival of only 4 months. This is the time after which 50% of people remain alive and 50% have died from their disease.  That said, among people who have treatment for oligometastses (only a few metastases) to the brain, outcomes are highly variable, and long-term survivors do exist.

Sources:

Ashworth, A. et al. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer. 2013. 82(2):197-203.

Gaspar, L. et al. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence based clinical practice guideline. Journal of Neuro-oncology. 2010. 96(1):17-32.

Kalkanis, S. et al. The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. Journal of Neuro-oncology. 2010. 96(1):33-43.

Linskey, M. et al. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. Jounral of Neuro-oncology. 2010. 96(1):45-68.

Mehta, M. et al. The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. Journal of Neuro-oncology. 2010. 96(1):71-83.

Ricciardi, S. and F. de Marinis. Multimodality management of non-small cell lung cancer patients with brain metastases. Current Opinion in Oncology. 2010. 22(2):86-93.

Walbert, T. and M. Gilbert. The role of chemotherapy in the treatment of patients with brain metastases from solid tumors. International Journal of Clinical Oncology. 2009. 14(4):299-306.

Yamanaka, R. Medical management of brain metastases from lung cancer (Review). Oncology Reports. 2009. 22(6):1169-76.

Villarreal-Garza, C. et al. Agressive treatment of primary tumor in patients with non-small-cell lung cancer and exclusively brain metastases. Clinical Lung Cancer. 2013. 14(1):6-13.

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