More targeted than SRS?

June 20, 2017. We know stereotactic radiosurgery (SRS) has obvious advantages over whole brain radiation (WBRT) in terms of local control and cognitive side effects. But in the molecular era, should the real target volume be the driving mutations themselves? You may have heard medical oncologists voicing a growing interest in trying targeted agents before RT in patients with non-small cell lung cancer (NSCLC) brain mets. This JAMA Onc synopsis of recent clinical trials for EGFR- and ALK-targeted therapies for advanced NSCLC shows promising blood-brain barrier penetration and intracranial progression-free survival when compared to the crop-dusting approaches of conventional chemotherapy and/or WBRT. When EGFR-targeted therapies are used to delay radiosurgery (SRS), on the other hand, there appears to be a survival deteriment. For now, we'll stick with targeting gadolinium in the brain first.

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