{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:36:01Z","timestamp":1786451761820,"version":"build-2736575974"},"reference-count":159,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Brain metastases (BrM) are a major cause of morbidity in patients with non\u2013small-cell lung cancer (NSCLC). As global populations age and systemic therapies improve survival, the number of older individuals presenting with BrM continues to rise. However, older adults remain underrepresented in clinical trials. Thus, treatment decisions in this population are often based on limited evidence from randomized prospective studies. Beyond chronological age, older adults with cancer frequently present with multiple comorbidities, frailty, baseline cognitive impairment, and reduced physiologic reserve. These factors may contribute to suboptimal treatment in clinical practice and highlight that age alone is an insufficient surrogate for vulnerability, underscoring the need for individualized geriatric assessment. In this review, we summarize the available evidence for CNS-directed and systemic therapies in older patients with NSCLC and BrM, discuss the options for local and systemic treatment strategies, and examine how geriatric assessment tools can inform individualized treatment decisions in this underrepresented population.<\/jats:p>","DOI":"10.3389\/fonc.2026.1858724","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:25:55Z","timestamp":1785212755000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of brain metastases in older adults with non\u2013small cell lung cancer"],"prefix":"10.3389","volume":"16","author":[{"given":"Julia","family":"Belone Lopes","sequence":"first","affiliation":[{"name":"Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schep","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Sahgal","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo F.","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, St. Michael\u2019s Hospital, University of Toronto","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines B.","family":"Menjak","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto","place":["Toronto, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1200\/GO.20.00629","article-title":"Assessment of brain metastasis at diagnosis in non-small-cell lung cancer: a prospective observational study from North India","volume":"7","author":"Naresh","year":"2021","journal-title":"JCO Glob Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2015.01.020","article-title":"Brain metastases in patients with EGFR-mutated or ALK-rearranged non-small-cell lung cancers","volume":"88","author":"Rangachari","year":"2015","journal-title":"Lung Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.41.6727","article-title":"Under-representation of older adults in cancer registration trials: known problem, little progress","volume":"30","author":"Scher","year":"2012","journal-title":"J Clin Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2019-rbmlc-05","article-title":"Management of brain metastases in elderly patients with lung cancer","volume":"13","author":"Socha","year":"2021","journal-title":"J Thorac Dis"},{"key":"B5","unstructured":"NCCN Clinical Practice Guidelines in Oncology: Older Adult Oncology. 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