Is it time to reevaluate our approach to the treatment of brain metastases in patients with non-small cell lung cancer?

Brain metastases from non-small cell lung cancer develop in approximately one-third of patients. If not treated, neurological deterioration occurs quickly. Treatment with whole brain irradiation is advisable to palliate symptoms but despite this treatment, survival remains poor at 3-6 months. Recently, aggressive approaches with surgical resection and stereotactic radiosurgery have dramatically improved the control of brain metastases resulting in a meaningful survival advantage for a subset of eligible patients. New evidence also suggests a possible role for chemotherapy in the treatment of brain metastases. With several options now available to treat brain metastases proper patient selection is needed. This article will stratify patients with brain metastases and discuss the treatment modalities for each category.