Zhang Min, Nie Ligong, Zhang Jiayong
Department of Radiation Therapy, Peking University First Hospital, Beijing 100034, China.
Department of Pulmonary and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Zhongguo Fei Ai Za Zhi. 2016 Aug 20;19(8):525-9. doi: 10.3779/j.issn.1009-3419.2016.08.07.
Lung cancer with brain metastasis had poor prognosis. Crizotinib had been confirmed to be used in ROS1 (C-ros oncogene 1 receptor tyrosine kinase) rearranged lung adenocarcinoma, but its efficacy in lung cancer with brain metastasis was poor due to the blood brain barrier. In the present study, we reported one case of ROS1 fusion lung adenocarcinoma with symptomatic brain matastasis, who was treated with brain metastases resection, crizotinib, and whole brain radiotherapy plus boost to residual brain metastasis. The safety and efficacy was summarized.
At first, surgical resection was used to relive mass effect and to biopsy. Then crizotinib (250 mg, bid) was chosen for the existence of ROS1 fusion gene. Whole brain radiotherapy plus boost to residual brain metastasis were used after surgery. Objective response was evaluated by Response Evaluation Criteriation in Solid Tumours (RECIST) v1.1 and brain metastasis were evaluated by computer tomography (CT)/magnetic resonance imaging (MRI) image. Adverse events were evaluated according to Common Terminology Criteria for Adverse Events (CTC AE) v4.0.
After taking crizotinib for 3 months, the lung lesions were close to complete response (CR), the brain metastasis were partial response (PR), the abdomen metastasis were CR and the symptom of blurred vision relieved.
Crizotinib combined with palliative operation and radiation therapy (WBRT plus boost to residual brain metastasis) in the treatment of ROS1 fusion gene positive lung adenocarcinoma with symptomatic brain metastases, can effectively control intracranial lesions with good tolerance.
伴有脑转移的肺癌预后较差。克唑替尼已被证实可用于ROS1（C-ros原癌基因1受体酪氨酸激酶）重排的肺腺癌，但由于血脑屏障，其在伴有脑转移的肺癌中的疗效不佳。在本研究中，我们报告了1例伴有症状性脑转移的ROS1融合型肺腺癌患者，该患者接受了脑转移瘤切除术、克唑替尼治疗以及全脑放疗加对残留脑转移灶的推量放疗，并总结了其安全性和疗效。
首先，采用手术切除以减轻肿块效应并进行活检。然后，因存在ROS1融合基因而选用克唑替尼（250mg，每日2次）。术后采用全脑放疗加对残留脑转移灶的推量放疗。通过实体瘤疗效评价标准（RECIST）v1.1评估客观缓解情况，通过计算机断层扫描（CT）/磁共振成像（MRI）图像评估脑转移情况。根据不良事件通用术语标准（CTC AE）v4.0评估不良事件。
服用克唑替尼3个月后，肺部病灶接近完全缓解（CR），脑转移灶部分缓解（PR），腹部转移灶CR，视力模糊症状缓解。
克唑替尼联合姑息性手术及放疗（全脑放疗加对残留脑转移灶的推量放疗）治疗伴有症状性脑转移的ROS1融合基因阳性肺腺癌，可有效控制颅内病灶，耐受性良好。
