Universität zu Köln

Kaul, David, Berghoff, Anna Sophie, Grosu, Anca-Ligia, Lucas, Carolin Weiss and Guckenberger, Matthias (2021). Focal Radiotherapy of Brain Metastases in Combination With Immunotherapy and Targeted Drug Therapy. Dtsch. Arztebl. Int., 118 (45). S. 759 - 770. COLOGNE: DEUTSCHER AERZTE-VERLAG GMBH. ISSN 1866-0452

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Abstract

Background: Advances in systemic treatment and in brain imaging have led to a higher incidence of diagnosed brain metastases. In the treatment of brain metastases, stereotactic radiotherapy and radiosurgery, systemic immunotherapy, and targeted drug therapy are important evidence-based options. In this review. we summarize the available evidence on the treatment of brain metastases of the three main types of cancer that give rise to them: non-small-cell lung cancer, breast cancer, and malignant melanoma. Methods: This narrative review is based on pertinent original articles. meta-analyses. and systematic reviews that were retrieved by a selective search in PubMed. These publications were evaluated and discussed by an expert panel including radiation oncologists. neurosurgeons. and oncologists. Results: There have not yet been any prospective randomized trials concerning the optimal combination of local stereotactic radiotherapy/radiosurgery and systemic immunotherapy or targeted therapy. Retrospective studies have consistently shown a benefit from early combined treatment with systemic therapy and (in particular) focal radiotherapy. compared to sequential treatment. Two meta-analyses of retrospective data from cohorts consisting mainly of patients with non-small-cell lung cancer and melanoma revealed longer overall survival after combined treatment with focal radiotherapy and checkpoint inhibitor therapy (rate of 12-month overall survival for combined versus non-combined treatment: 64.6% vs. 51.6%, p <0.001). In selected patients with small, asymptomatic brain metastases in non-critical locations. systemic therapy without focal radiotherapy can be considered, as long as follow-up with cranial magnetic resonance imaging can be performed at close intervals. Conclusion: Brain metastases should be treated by a multidisciplinary team, so that the optimal sequence of local and systemic therapies can be determined for each individual patient.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kaul, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Berghoff, Anna Sophie UNSPECIFIED UNSPECIFIED UNSPECIFIED Grosu, Anca-Ligia UNSPECIFIED UNSPECIFIED UNSPECIFIED Lucas, Carolin Weiss UNSPECIFIED UNSPECIFIED UNSPECIFIED Guckenberger, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-598386
DOI:	10.3238/arztebl.m2021.0332
Journal or Publication Title:	Dtsch. Arztebl. Int.
Volume:	118
Number:	45
Page Range:	S. 759 - 770
Date:	2021
Publisher:	DEUTSCHER AERZTE-VERLAG GMBH
Place of Publication:	COLOGNE
ISSN:	1866-0452
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CELL LUNG-CANCER; STEREOTACTIC RADIOSURGERY; RADIATION-THERAPY; OPEN-LABEL; MELANOMA; IPILIMUMAB; MANAGEMENT; SURVIVAL; EFFICACY; IMPACT Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59838