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Strategies to prevent brain metastasis

Soffietti, Riccardo; Pellerino, Alessia; Rudà, Roberta

doi: 10.1097/CCO.0000000000000572
BRAIN AND NERVOUS SYSTEM: Edited by Marc Sanson
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Purpose of review The current article reviews the state of art of prevention strategies for brain metastases from solid tumors and touches both old pivotal studies and new directions of personalized molecular approaches.

Recent findings Prophylactic cranial irradiation (PCI) has a definite role in the prevention of relapse into the brain for patients with small cell lung cancer (SCLC) responding to chemotherapy and radiotherapy as it prolongs overall survival (OS). However, the risk of late cognitive deficit following whole brain radiotherapy (WBRT) in this patient population is still not well known. Conversely, PCI significantly reduces the incidence of brain metastases and prolongs the disease-free interval in patients with non-SCLC (NSCLC), but does not improve OS thus far. Pharmacologic prevention is a new concept driven by the efficacy of targeted agents on macrometastases from specific molecular subgroups.

Summary The future challenges for prevention of brain metastases are represented by the identification of subgroups of patients at higher risk of relapse into the brain coupled with either new WBRT strategies to better preserve cognition or effective molecular agents to target micrometastases.

Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy

Correspondence to Riccardo Soffietti, MD, Prof Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126 Turin, Italy. Tel: +39 0116334904; e-mail: riccardo.soffietti@unito.it

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