Advances in imaging as well as new systemic treatment options, particularly targeted and immunotherapeutic approaches have led to longer overall survival and an increasing incidence of brain metastases. Traditionally, neurosurgical approaches, as well as whole-brain radiation therapy, and best supportive care have been used therapeutically. In addition, stereotactic radiotherapy or radiosurgery and new targeted therapies are available today. In selected cases these immune- or targeted therapies have a higher clinical response rate than chemotherapies, both extra- and intracranial.

Optimal multimodal treatment of brain metastases is a particular challenge. Randomized trials have established durable metastatic control with better or equal overall survival after radiosurgery. However, these studies stem from the era before availability of effective systemic therapy. Similarly, targeted and immunotherapeutic drugs are now evidence-based treatment standards, but trials often excluded patients with symptomatic brain metastases. Only in secondary analyses selected drugs were shown to have high cerebral activity.

The increasing use of targeted therapy has resulted in prolonged survival in many metastatic cancers. Local radiotherapy of brain metastases has the potential to obtain a durable control of resistant metastases. Our main goals for this Research Topic are the following:
Firstly, Optimal timing and treatment sequence of radiotherapy and immune- and targeted therapy need to be further investigated. Secondly, the biology of brain metastases with regard to precision therapy approaches needs to be further elucidated. In order to decide which therapeutic approach is necessary for the individual patient the investigation of genetic and epigenetic alterations of brain metastases as well as their microenvironment is necessary. Thirdly, Precise personalized medicine should not only be applied in curative and early metastasized settings, but also in end-of-life care. Thus we especially aim at including works with a palliative focus.

Articles will include Original Research Articles and Reviews.
Manuscripts should cover the following topics:
1) Targeted therapy, immunotherapy, stereotactic radiotherapy and radiosurgery and especially their combination in treating brain metastases.
2) The molecular biology of brain metastases with special regard to the mentioned treatment approaches.
3) The potential role of personalized treatment approaches in end-of-life care of patients with brain metastases.

Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which 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.

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