Wang Yan, Yang Xue, Li Nan-Jing, Xue Jian-Xin
Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Lung Cancer. 2022 Dec;174:1-13. doi: 10.1016/j.lungcan.2022.09.013. Epub 2022 Oct 1.
Leptomeningeal metastasis (LM) is a rare complication of non-small cell lung cancer (NSCLC) with highly mortality. LM will occur once tumor cells spread to the cerebrospinal fluid (CSF) space. Patients may suffer blindness, paralysis, and mental disorders that seriously affect their quality of life. There is a clear unmet need to improve the efficacy of diagnosis and treatment of LM. To better solve this problem, it is helpful to clarify the potential mechanisms of LM. Clinical manifestations, magnetic resonance imaging, and CSF biopsy are the key components in the diagnosis of NSCLC with LM. CSF cytology is insufficient and should be combined with liquid biology. The application of radiotherapy, intrathecal treatment, targeted therapy and immunotherapy provides more options for LM patients. Each treatment has a particular level of efficacy and can be used alone or in combination for individual patients. New technologies in radiotherapy, drug repositioning in intrathecal treatment, and the higher CSF permeability in TKIs have brought new breakthroughs in the treatment of LM. This review focused on clarifying the potential mechanisms, discussing the major clinical challenges, and summarizing recent advances in the diagnosis and treatment of LM from NSCLC. Future research is essential to improve the efficiency of diagnosis, to optimize therapy and to enhance patient prognosis.
软脑膜转移（LM）是非小细胞肺癌（NSCLC）的一种罕见并发症，死亡率很高。一旦肿瘤细胞扩散到脑脊液（CSF）空间，就会发生LM。患者可能会出现失明、瘫痪和精神障碍，严重影响他们的生活质量。显然，提高LM的诊断和治疗效果存在未满足的需求。为了更好地解决这个问题，阐明LM的潜在机制会有所帮助。临床表现、磁共振成像和脑脊液活检是诊断NSCLC合并LM的关键组成部分。脑脊液细胞学检查不够充分，应与液体生物学相结合。放射治疗、鞘内治疗、靶向治疗和免疫治疗的应用为LM患者提供了更多选择。每种治疗都有特定的疗效水平，可以单独使用或联合用于个体患者。放射治疗的新技术、鞘内治疗中的药物重新定位以及酪氨酸激酶抑制剂（TKIs）中更高的脑脊液渗透性为LM的治疗带来了新突破。本综述重点在于阐明潜在机制、讨论主要临床挑战以及总结NSCLC合并LM诊断和治疗的最新进展。未来的研究对于提高诊断效率、优化治疗和改善患者预后至关重要。
