Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases
Brain metastasis (BM) represents a common complication of cancer, and in the modern era requires multi-modal management approaches and multi-disciplinary care. Traditionally, due to the limited efficacy of cytotoxic chemotherapy, treatment strategies are focused on local treatments alone, such as wh...
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doaj-89e3e9bff5c04187a37c98918c9951322021-08-06T15:20:07ZengMDPI AGCancers2072-66942021-07-01133682368210.3390/cancers13153682Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain MetastasesRaees Tonse0Martin C. Tom1Minesh P. Mehta2Manmeet S. Ahluwalia3Rupesh Kotecha4Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USADepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USADepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USAHerbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USADepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USABrain metastasis (BM) represents a common complication of cancer, and in the modern era requires multi-modal management approaches and multi-disciplinary care. Traditionally, due to the limited efficacy of cytotoxic chemotherapy, treatment strategies are focused on local treatments alone, such as whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and resection. However, the increased availability of molecular-based therapies with central nervous system (CNS) penetration now permits the individualized selection of tailored systemic therapies to be used alongside local treatments. Moreover, the introduction of immune checkpoint inhibitors (ICIs), with demonstrated CNS activity has further revolutionized the management of BM patients. The rapid introduction of these cancer therapeutics into clinical practice, however, has led to a significant dearth in the published literature about the optimal timing, sequencing, and combination of these systemic therapies along with SRS. This manuscript reviews the impact of tumor biology and molecular profiles on the management paradigm for BM patients and critically analyzes the current landscape of SRS, with a specific focus on integration with systemic therapy. We also discuss emerging treatment strategies combining SRS and ICIs, the impact of timing and the sequencing of these therapies around SRS, the effect of corticosteroids, and review post-treatment imaging findings, including pseudo-progression and radiation necrosis.https://www.mdpi.com/2072-6694/13/15/3682stereotactic radiosurgerychemotherapytargeted therapyimmunotherapybrain metastases |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Raees Tonse Martin C. Tom Minesh P. Mehta Manmeet S. Ahluwalia Rupesh Kotecha |
spellingShingle |
Raees Tonse Martin C. Tom Minesh P. Mehta Manmeet S. Ahluwalia Rupesh Kotecha Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases Cancers stereotactic radiosurgery chemotherapy targeted therapy immunotherapy brain metastases |
author_facet |
Raees Tonse Martin C. Tom Minesh P. Mehta Manmeet S. Ahluwalia Rupesh Kotecha |
author_sort |
Raees Tonse |
title |
Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases |
title_short |
Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases |
title_full |
Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases |
title_fullStr |
Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases |
title_full_unstemmed |
Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases |
title_sort |
integration of systemic therapy and stereotactic radiosurgery for brain metastases |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2021-07-01 |
description |
Brain metastasis (BM) represents a common complication of cancer, and in the modern era requires multi-modal management approaches and multi-disciplinary care. Traditionally, due to the limited efficacy of cytotoxic chemotherapy, treatment strategies are focused on local treatments alone, such as whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and resection. However, the increased availability of molecular-based therapies with central nervous system (CNS) penetration now permits the individualized selection of tailored systemic therapies to be used alongside local treatments. Moreover, the introduction of immune checkpoint inhibitors (ICIs), with demonstrated CNS activity has further revolutionized the management of BM patients. The rapid introduction of these cancer therapeutics into clinical practice, however, has led to a significant dearth in the published literature about the optimal timing, sequencing, and combination of these systemic therapies along with SRS. This manuscript reviews the impact of tumor biology and molecular profiles on the management paradigm for BM patients and critically analyzes the current landscape of SRS, with a specific focus on integration with systemic therapy. We also discuss emerging treatment strategies combining SRS and ICIs, the impact of timing and the sequencing of these therapies around SRS, the effect of corticosteroids, and review post-treatment imaging findings, including pseudo-progression and radiation necrosis. |
topic |
stereotactic radiosurgery chemotherapy targeted therapy immunotherapy brain metastases |
url |
https://www.mdpi.com/2072-6694/13/15/3682 |
work_keys_str_mv |
AT raeestonse integrationofsystemictherapyandstereotacticradiosurgeryforbrainmetastases AT martinctom integrationofsystemictherapyandstereotacticradiosurgeryforbrainmetastases AT mineshpmehta integrationofsystemictherapyandstereotacticradiosurgeryforbrainmetastases AT manmeetsahluwalia integrationofsystemictherapyandstereotacticradiosurgeryforbrainmetastases AT rupeshkotecha integrationofsystemictherapyandstereotacticradiosurgeryforbrainmetastases |
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