BalajiSubramanian Sitaraman, Al Hajri Thuraya, Satyapal Namrata, Laiq Simin, Al Hajri Zahra
Department of Radiation Oncology, Royal Hospital, Muscat, OMN.
Department of Pathology, Khoula Hospital, Muscat, OMN.
Cureus. 2023 Mar 9;15(3):e35952. doi: 10.7759/cureus.35952. eCollection 2023 Mar.
Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) has a higher incidence of brain metastasis. Despite having a favorable prognosis and relatively long survival with second-generation ALK tyrosine kinase inhibitors (TKI), patients can have substantial morbidity, negatively affecting functional progression-free and symptom-free survival. Studies have shown that ALK-rearranged NSCLC is a risk factor for developing radiation necrosis (RN). Recently, second-generation TKI, especially lorlatinib, alectinib, and brigatinib, have demonstrated good central nervous system (CNS) penetration and overall response rates in patients with brain metastasis. However, to improve overall outcomes in symptomatic or limited brain metastases, stereotactic radiosurgery (SRS) is increasingly preferred over whole brain radiotherapy (WBRT) prior to systemic therapy to avoid significant cognitive deterioration. To improve the therapeutic ratio, fractionated stereotactic radiotherapy (FSRT) has been explored for brain metastasis. Herein, we report on one ALK-rearranged NSCLC patient who developed RN despite FSRT, one year after the completion of radiotherapy while on alectinib.
间变性淋巴瘤激酶（ALK）阳性非小细胞肺癌（NSCLC）发生脑转移的几率更高。尽管使用第二代ALK酪氨酸激酶抑制剂（TKI）预后良好且生存期相对较长，但患者仍可能出现严重的并发症，对无功能进展生存期和无症状生存期产生负面影响。研究表明，ALK重排的NSCLC是发生放射性坏死（RN）的一个危险因素。最近，第二代TKI，尤其是劳拉替尼、阿来替尼和布加替尼，已在脑转移患者中显示出良好的中枢神经系统（CNS）穿透率和总体缓解率。然而，为了改善有症状或局限性脑转移患者的总体预后，在全身治疗前，立体定向放射外科（SRS）比全脑放疗（WBRT）更受青睐，以避免严重的认知功能恶化。为了提高治疗比，人们已对分割立体定向放射治疗（FSRT）用于脑转移进行了探索。在此，我们报告1例ALK重排的NSCLC患者，在完成放疗一年后，尽管接受了FSRT，但在服用阿来替尼期间仍发生了RN。
