Stereotactic radiosurgery is associated with better long-term cognitive function than whole-brain radiotherapy in people with a limited number of brain metastases, suggests a secondary analysis of a clinical trial.

Patients with small-cell lung cancer and brain metastases may benefit from first-line treatment with stereotactic radiosurgery, suggest findings from the FIRE-SCLC study.

A total of four studies, reported in five publications between August 2016 and April 2021, form the evidentiary base for the recommendations, which cover local therapies, such as surgery, whole-brain radiotherapy, and stereotactic radiosurgery, as well as systemic therapy.

The team therefore identified 171 NSCLC patients aged a median of 62 years who received radiotherapy (local, whole-brain, or stereotactic radiosurgery) plus at least two cycles of either ICIs (n=63) or platinum-based chemotherapy (n=108) after undergoing resection of brain metastases at one of the three sites of the Charité University Medical Hospital in Germany during 2010–2021.

Neurosurgical resection of brain metastases followed by stereotactic radiation can lead to pachymeningeal seeding outside of the stereotactic radiation field, according to findings reported in JAMA Oncology .

He was treated with ipilimumab plus nivolumab until March 2020, with the exception of a break to undergo neurosurgical resection followed by stereotactic radiosurgery (SRS) for brain metastases.

In this roundup, we cover the roles of stereotactic radiosurgery in patients undergoing resection for intracranial metastases and nimotuzumab in the first-line treatment of advanced pancreatic cancer, as well as the hepatotoxicity associated with inotuzumab ozogamicin.

They conclude: “EGFR TKIs are warranted in the treatment of EGFR -mutant NSCLC with brain metastases; however, we highly recommend the initial ablation of brain metastases by stereotactic radiosurgery to optimise patient outcome.”

The researchers note that when metastases are identified early, they are more amenable to potentially less toxic treatments, such as stereotactic radiosurgery or systemic chemotherapy, than when detected at a later stage.