Summary of breakthrough session and future directions
| Topic discussed in breakout session | Summary management from breakout session | Future directions/open questions |
| Screening for BM | Especially in stage III Stage IV with driver alterations No consensus on stage IB/II MRI preferred Follow-up only in BM and driver altered patients | Evaluate whether screening improves QoL and OS Improved prediction models for risk of BM development needed Improved imaging techniques needed |
| Selection for BM treatment | Prognostic scores mainly used by radiation oncologist Prognostic scores do not consider available systemic treatment options Performance status important for treatment selection | Evaluate prognostic scores incorporating whether there are systemic treatment options available with intracranial activity |
| Selection of treatment type | Preferably local treatment in neurologically symptomatic patients Systemic treatment in neurologically asymptomatic patients preferred above WBRT; discussion on SRT No consensus on treatment sequence in driver mutated patients (SRT upfront versus TKI upfront) If available, next generation TKIs preferred in driver altered patients No consensus on concurrent TKI and cranial irradiation | Specific trials for BM patients evaluating systemic treatment combinations (e.g. ICI plus chemotherapy, and/or angiogenesis inhibition) Evaluate best treatment strategy in randomised trials (SRT followed by systemic treatment and vice versa) Evaluate safety of concurrent TKI and cranial irradiation |
BM: brain metastases; MRI: magnetic resonance imaging; QoL: quality of life; OS: overall survival; WBRT: whole brain irradiation; SRT: stereotactic radiotherapy; TKI: tyrosine kinase inhibitor; ICI: immune checkpoint inhibitor.