Parth J. Sampat ^* Alyssa Cortese Alexandra Goodman Ghanshyam H. Ghelani Michael D. Mix Stephen Graziano Alina Basnet

• Upstate Medical University, Syracuse, United States

Lung cancer is the second most common type of cancer and is the leading cause of cancer-related deaths in the United States. Approximately 10-40% of patients with solid tumors develop brain metastases, with non-small cell lung cancer accounting for approximately 50% of all cases of patients with brain metastases. Many management options are available which can include surgery, radiation, and systemic therapy. A variety of factors go into the selection of management of brain metastases. In this review, we will focus on the treatment strategies and optimizing the management of brain metastases in patients with non-small cell lung cancer.All patients with symptomatic brain metastases should be offered local therapy with surgery or radiation therapy in addition to systemic steroids to minimize swelling or vasogenic edema that may be present. Refer to sections covering their role for detailed discussion.With the significant growth in treatment options and shifting landscape for patients with advanced NSCLC, it becomes increasingly important to have an open discussion with the patient regarding their current clinical and molecular status, findings, and how it influences their treatment options. At this time, more people are living with and surviving from lung cancer than ever before. Shared decision-making with the patient has become pivotal and the oncologist needs to guide patients to determine the best individualized treatment plan based on treatment side effects, functional status, goals of care, and patient expectations regarding quality of life. A multi-disciplinary approach and discussion between neurosurgery, medical oncology, radiation oncology, and neuro-oncology, along with the patient preferences is important to develop an individualized treatment plan.