Whole-brain radiotherapy for NSCLC patients with multiple brain metastases – an update

Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancers, with the majority of patients having advanced disease at presentation. Between 10-20% present with brain metastases (BM) and up to 40% of patients will develop BM. The overall median survival is reported to average three to four months if treated with whole brain radiotherapy (WBRT) alone. Management of BM patients conventionally involved steroids to reduce brain oedema, and WBRT alone for patients with multiple BM or combined with surgery or stereotactic radiosurgery (SRS) for oligo BM, followed by systemic chemotherapy for patients with good performance status. The progress made in radiotherapy techniques and the introduction of tyrosine kinase inhibitors (TKIs) targeted against oncogenic drivers such as epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK)rearranged NSCLC have prompted us to re-evaluate the current management strategies for NSCLC patients with multiple BM.