Department of Hematology/Oncology, Lenox Hill Hospital, New York, New York, USA.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
BMJ Case Rep. 2023 Nov 28;16(11):e256758. doi: 10.1136/bcr-2023-256758.
Radionecrosis describes a rare but serious complication of radiation therapy. In clinical practice, stereotactic radiosurgery (SRS) is increasingly used in combination with systemic therapy, including chemotherapy, immune checkpoint inhibitor and targeted therapy, either concurrently or sequentially. There is a paucity of literature regarding radionecrosis in patients receiving whole brain radiation therapy (WBRT) alone (without additional SRS) in combination with immunotherapy or targeted therapies. It is observed that certain combinations increase the overall radiosensitivity of the tumorous lesions. We present a rare case of symptomatic radionecrosis almost 1 year after WBRT in a patient with non-squamous non-small cell lung cancer on third-line chemoimmunotherapy. We discuss available research regarding factors that may lead to radionecrosis in these patients, including molecular and genetic profiles, specific drug therapy combinations and their timing or increased overall survival.
放射性坏死是放疗后罕见但严重的并发症。在临床实践中，立体定向放射外科（SRS）越来越多地与系统治疗（包括化疗、免疫检查点抑制剂和靶向治疗）联合使用，无论是同步还是序贯治疗。关于单独接受全脑放疗（不额外进行 SRS）联合免疫治疗或靶向治疗的患者发生放射性坏死的文献很少。据观察，某些组合会增加肿瘤病变的整体放射敏感性。我们报告了一例三线化疗免疫治疗的非鳞状非小细胞肺癌患者在全脑放疗后近 1 年发生症状性放射性坏死的罕见病例。我们讨论了可能导致这些患者发生放射性坏死的相关研究，包括分子和遗传特征、特定药物治疗组合及其时间或总体生存时间的影响。
