Brain and Leptomeningeal Metastases in Lung Cancer

Lung cancer is one of the most frequent malignant tumors worldwide, with 84% of all lung cancers enlisted as non-small cell lung cancers (NSCLCs) and about 13% of them as small-cell lung cancers (SCLCs). The majority of patients with lung cancer present with an advanced stage of the disease when diagnosed. NSCLCs and SCLCs demonstrate high incidence of central nervous system dissemination, with approximately 40% of patients developing brain metastases and a smaller percentage, 3-5%, developing leptomeningeal ones during the course of their disease.

First-line treatment for stage IV NSCLC changed considerably, however treating central nervous system dissemination is still a challenge. This is confirmed also for SCLC where brain metastases present distinct clinical characteristics reflected also in radio and chemo-sensitivity but high aggressiveness with rapid evolution.

The prognosis of patients with central nervous system dissemination from lung cancer is still poor as documented in both retrospective and prospective studies. Patients with brain metastases from NSCLC are usually excluded from clinical trials if not treated, and SCLC ones are also excluded from those on the management of brain metastases due to the different biological behavior of the primary tumor. On the contrary, treatments particularly for stage IV NSCLC and then for advanced SCLC, primarily as a result of a better patient selection on the basis of histology, molecular markers, and because of innovative treatment approaches, are widely improving.

The aim of this Research Topic is to highlight the state of research in advanced lung cancer with central nervous system dissemination focusing also on selected sub-populations such as patients with oncogene-addicted NSCLC, oligo-metastatic NSCLC disease, and patients with brain or leptomeningeal metastasis who underwent immunotherapy or other innovative systemic or local approaches.

We welcome Reviews, Original Research, and Clinical Studies that aim to frame and deepen this fundamental and challenging topic whilst documenting the state of research and scientific improvements in advanced lung cancer with central nervous system dissemination. We welcome submissions on:
- Epidemiology and biology of brain metastases or leptomeningeal dissemination in lung cancer.
- Advances in imaging of lung cancer brain metastases or leptomeningeal dissemination.
- Critical issues in clinical trial methodology for lung cancer patients with brain or central nervous system dissemination.
- Quality of life of lung cancer patients with brain metastases or leptomeningeal dissemination.
- Focus on elderly lung cancer patients with brain metastases or leptomeningeal dissemination.
- Systemic treatments in patients with oncogene-addicted NSCLC and brain metastases or leptomeningeal dissemination.
- Local approaches for NSCLC patients with brain metastases or leptomeningeal dissemination.
- Immunotherapy in NSCLC patients with brain metastases.
- Management of leptomeningeal metastasis in NSCLC patients.
- Management of SCLC patients with brain metastases or leptomeningeal dissemination.

Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases that are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.