Neurologic complications of lung cancer

Abstract

Lung cancer frequently causes neurological complications from direct and indirect effects. Brain metastases occur in 41% of patients with non-small cell lung cancer and 35% with small cell lung cancer at autopsy. Presenting symptoms can be quite protean. MRI continues to be the gold standard of detecting metastases. Biopsy or resection should be considered for patients with a single lesion, but is not necessary in the case of multiple metastases and a known history of cancer. Removal of single lesions impacts favorably on survival and allows for the rapid tapering of glucocorticoids. Radiation therapy standards are evolving from wide use of whole-brain radiotherapy to consideration of more focused radiosurgery in selected patients to avoid long-term neurotoxicity. The role of chemotherapy in the treatment of brain metastases is still evolving as results of ongoing randomized and controlled trials using newer blood-brain barrier penetrating agents. © 2008 Humana Press, Totowa, NJ.