The occurrence of brain metastases in lung cancer substantially affects the quality of life by the deterioration of neurocognitive functions of patients and has been considered an event that quite inevitably leads to death. The prognosis of such patients has been considered poor. Median overall survival of unselected patients with brain metastases from lung cancer managed with whole-brain radiotherapy (WBRT), which was a mainstay of management of these patients, was 3–4 months (1,2). Historically, a standard treatment for brain metastases from lung cancer involved WBRT alone or WBRT combined with neurosurgical resection or stereotactic radiosurgery (SRS) for selected patients. The addition of SRS or neurosurgical resection to WBRT in patients with single brain metastasis prolonged overall survival (3-5). The use of chemotherapy for brain metastases from lung cancer has long been questioned because of the notion that drugs poorly penetrate through the blood-brain barrier, except for small-cell lung cancer (SCLC) due to its well-known chemoresponsiveness and a frequent presentation of brain metastases with extracranial progression. Despite the improvement of brain metastases control with WBRT, this treatment modality was not associated with improved overall survival in randomized clinical trials (6-9), and an increase in the risk of neurocognitive decline with WBRT use was demonstrated in some trials (8,9). Currently, in WHO performance status 0–2, patients with up to three brain metastases from non-small cell lung cancer (NSCLC), local therapy (surgery or SRS) without WBRT is recommended (10).
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