Radiosurgery and Immunotherapy in the Treatment of Brain Metastases

Rohan Ramakrishna; Silvia Formenti

doi:10.1016/j.wneu.2019.04.032

Radiosurgery and Immunotherapy in the Treatment of Brain Metastases

World Neurosurg. 2019 Oct:130:615-622. doi: 10.1016/j.wneu.2019.04.032.

Authors

Rohan Ramakrishna¹, Silvia Formenti²

Affiliations

¹ Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA. Electronic address: Ror9068@med.cornell.edu.
² Department of Radiation Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA.

PMID: 31581411
DOI: 10.1016/j.wneu.2019.04.032

Abstract

Radiation therapy represents a mainstay of treatment for patients with brain metastases. Recently, the widespread adoption of immune checkpoint blockade has led to keen interest in treating cancers with checkpoint inhibitors in place of, or as an adjunct to, traditional chemotherapy. However, with the exception of melanoma, immune checkpoint blockade in solid tumors has failed to achieve significant brain control in patients with brain metastases. The possibility of combining immune checkpoint blockade with radiation for the treatment of brain and other metastases represents an exciting new strategy that is in its early stages of investigation. Success with this combinatorial strategy has the potential to result in enhanced rates of brain control, less brain exposure to radiation, and improved cognitive outcomes. In this review, we discuss the mechanisms behind this synergy, describe its limitations, and suggest ways to move the field forward.

Keywords: Brain metastasis; Gamma Knife; Immunotherapy; Radiation necrosis; Stereotactic radiosurgery.

MeSH terms

Brain Neoplasms / immunology
Brain Neoplasms / secondary*
Brain Neoplasms / therapy*
Combined Modality Therapy / methods
Humans
Immunologic Factors / therapeutic use
Immunotherapy / methods*
Radiosurgery / methods*
Treatment Outcome

Substances

Immunologic Factors