Sarah Anderson, DNP, AGACNP-BC, OCN, WCC, of RUSH MD Anderson Cancer Center, outlined treatment approaches for lung cancer patients with brain metastases at JADPRO Live, the annual APSHO meeting. She emphasized a multidisciplinary approach that balances local control of brain lesions with ongoing systemic therapy.
Patients with a single brain metastasis are often managed under an oligometastatic paradigm: standard treatment for the primary lung tumor combined with targeted therapy to the brain lesion. Decisions hinge on symptoms, lesion size and location, overall disease status, and whether planned systemic therapies penetrate the central nervous system.
When a patient will start a systemic therapy known to reach the CNS, clinicians may closely observe a small, asymptomatic brain metastasis with brain MRI every 2–3 months. Lesions 3 millimeters or smaller are frequently monitored, since very small lesions may not always represent metastasis. Lesions between 3 and 6 millimeters are often observed for treatment response before intervening.
A lesion larger than 6 millimeters, the presence of swelling, or neurological symptoms typically prompts discussion of surgical resection for immediate symptom relief. Radiation can reduce tumor size but does not provide instant symptom relief and may initially increase swelling as the tumor responds.
When surgery is not preferred or to avoid delaying systemic therapy, stereotactic radiosurgery (SRS) is commonly used. SRS delivers precise, high-dose radiation to lesions, preserving cognitive function compared with whole-brain radiation. It can treat multiple sites—often up to 10–15 lesions—and has been associated with favorable progression-free and overall survival outcomes in selected patients.
Following local treatment, patients generally continue systemic therapy and are monitored with routine re-staging scans to assess treatment response and detect new intracranial disease.
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