Luciano Angelo, Liguori Luigi, Polcaro Giovanna, Sabbatino Francesco, Pepe Stefano
Oncology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy.
Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
Clin Pract. 2023 Nov 30;13(6):1549-1560. doi: 10.3390/clinpract13060136.
Non-small cell lung cancer (NSCLC) is the second most common cancer worldwide, resulting in 1.8 million deaths per year. Most patients are diagnosed with a metastatic disease. Brain metastases are one of the most common metastatic sites and are associated with severe neurological symptoms, shorter survival, and the worst clinical outcomes. Brain radiotherapy and systemic oncological therapies are currently used for controlling both cancer progression and neurological symptoms. Brain radiotherapy includes stereotactic brain ablative radiotherapy (SBRT) or whole brain radiotherapy (WBRT). SBRT is applied for single or multiple (up to ten) small (diameter less than 4 cm) lesions, whereas WBRT is usually applied for multiple (more than ten) and large (diameter greater than 4 cm) brain metastases. In both cases, radiotherapy application may be viewed as an overtreatment which causes severe toxicities without achieving a significant clinical benefit. Thus far, a number of scoring systems to define the potential clinical benefits derived from brain radiotherapy have been proposed. However, most are not well established in clinical practice. In this article, we present a clinical case of a patient with advanced NSCLC carrying a BRAF mutation and brain metastases. We review the variables in addition to applicable scoring systems considered to have potential for predicting clinical outcomes and benefits of brain radiotherapy in patients with advanced NSCLC and brain metastases. Lastly, we highlight the unmet need of specific scoring systems for advanced NSCLC patients with brain metastases carrying oncogene alterations including BRAF mutations.
非小细胞肺癌（NSCLC）是全球第二大常见癌症，每年导致180万人死亡。大多数患者被诊断为转移性疾病。脑转移是最常见的转移部位之一，与严重的神经症状、较短的生存期和最差的临床结局相关。目前，脑放疗和全身肿瘤治疗用于控制癌症进展和神经症状。脑放疗包括立体定向脑消融放疗（SBRT）或全脑放疗（WBRT）。SBRT适用于单个或多个（最多十个）小（直径小于4厘米）病灶，而WBRT通常适用于多个（超过十个）和大（直径大于4厘米）脑转移瘤。在这两种情况下，放疗的应用可能被视为过度治疗，会导致严重毒性且未获得显著临床益处。到目前为止，已经提出了许多评分系统来定义脑放疗潜在的临床益处。然而，大多数在临床实践中尚未得到充分确立。在本文中，我们展示了一例携带BRAF突变和脑转移的晚期NSCLC患者的临床病例。我们回顾了除适用的评分系统外，被认为有可能预测晚期NSCLC和脑转移患者脑放疗临床结局和益处的变量。最后，我们强调了针对携带包括BRAF突变在内的致癌基因改变的晚期NSCLC脑转移患者的特定评分系统的未满足需求。
