From the Department of Radiology (C.D., T.J.R., D.A.S., N.H.R.), University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Department of Radiology and Imaging Sciences (T.J.R.), University of Utah Hospital, Salt Lake City, Utah.
AJNR Am J Neuroradiol. 2020 May;41(5):738-750. doi: 10.3174/ajnr.A6477. Epub 2020 Mar 26.
Treatment options for patients who develop brain metastases secondary to non-small-cell lung cancer have rapidly expanded in recent years. As a key adjunct to surgical and radiation therapy options, systemic therapies are now a critical component of the oncologic management of metastatic CNS disease in many patients with non-small-cell lung cancer. The aim of this review article was to provide a guide for radiologists, outlining the role of systemic therapies in metastatic non-small-cell lung cancer, with a focus on tyrosine kinase inhibitors. The critical role of the blood-brain barrier in the development of systemic therapies will be described. The final sections of this review will provide an overview of current imaging-based guidelines for therapy response. The utility of the Response Assessment in Neuro-Oncology criteria will be discussed, with a focus on how to use the response criteria in the assessment of patients treated with systemic and traditional therapies.
近年来,继发于非小细胞肺癌的脑转移患者的治疗选择迅速扩大。作为手术和放射治疗选择的重要辅助手段,系统治疗现在是许多非小细胞肺癌脑转移患者肿瘤治疗管理中的一个关键组成部分。本文综述的目的是为放射科医生提供指导,概述系统治疗在转移性非小细胞肺癌中的作用,重点是酪氨酸激酶抑制剂。血脑屏障在系统治疗发展中的关键作用将被描述。本综述的最后部分将概述目前基于影像学的治疗反应指南。将讨论神经肿瘤反应评估标准的实用性,重点是如何在评估接受系统治疗和传统治疗的患者时使用这些反应标准。