Although whole-brain radiation is the standard, radiosurgery may be the better option for certain patients with multiple brain metastases, according to a new study published in the Journal of Thoracic Oncology.

"For many radiation oncologists, whole brain radiation is recommended for all patients with more than three brain metastases," Dr. Tyler Robin of the University of Colorado Cancer Center, told HCB News. "Yet, to some extent this number was chosen arbitrarily, and our study now adds to an emerging body of data that this numeric cutoff might not be the best way to choose a therapy."

The study focused on a specific subset of patients with advanced ALK- or EGFR-mutated non-small cell lung cancer who received therapies that targeted those genetic drivers. Robin and his team found that there was no difference in survival for those treated with radiosurgery for four to 10 metastases and 10-plus metastases.

"For patients with four or more visible deposits, the concern is that the risk of deposits that cannot be seen is high, and therefore, targeting only what you can see might be futile," said Robin. "However, our study suggests that for select lung cancer patients with these targetable mutations, that a radiosurgery alone approach may actually be quite effective."

The team also found that even when over 10 brain metastases were treated in one session with radiosurgery, the dose administered was significantly lower than with whole-brain radiotherapy.

"We hope that when radiation oncologists see patients with multiple brain metastases that they will recall our study and others, and pause to consider if radiosurgery might be reasonable in lieu of whole brain radiation," said Robin.

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