Zhang Xian, Yang Jun, Hu Hong, Wang Yong, Zhang Zhenfeng, Lv Jinhao, Li Junping
Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, Hubei, China.
Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, Hubei, China.
Sci Rep. 2025 Jan 27;15(1):3318. doi: 10.1038/s41598-025-87422-9.
Brain metastases (BM) are the most prevalent intracranial malignancies. Approximately 30-40% of cancer patients develop BM at some stage of their illness, presenting with a high incidence and poor prognosis. Our clinical findings indicate a significant disparity in the efficacy between non-enhanced and enhanced lung cancer BM. Therefore, the aim of this study is to conduct a longitudinal MRI evaluation of the therapeutic effect of non-enhanced lung cancer BM, thereby enabling improved efficacy prediction and more personalized treatment plans. We conducted a retrospective analysis of clinical and imaging data from 72 patients with lung cancer BM. Exclusion criteria included participants with a history of primary brain tumors, other malignancies, or neurological symptoms. We performed a longitudinal MRI evaluation of 8 patients with non-enhanced BM who met the eligibility criteria. The response to systemic therapy was locally assessed using the Neuro-Oncology response assessment criteria (RANO 2.0). A total of 8 patients were included in this study, comprising 4 cases of non-enhanced BM and 4 cases featuring both enhanced and non-enhanced BM. The median follow-up time for non-enhanced BM was 19 months, with a disease control rate of 50%. In contrast, the median progression-free follow-up time for enhanced BM was 35.5 months, yielding a disease control rate of 100%. After standardized treatment in accordance with clinical guidelines, patients with enhanced BM exhibited significantly better therapeutic outcomes than those with non-enhanced BM. Cases 1-4 demonstrated non-enhanced or mildly circular-enhanced lung cancer BM, with the sizes of all 4 lesions increasing by over 60% within approximately one year, indicating disease progression. In cases 5-8, each patient presented with two lesions: enhanced (Foci 1) and non-enhanced (Foci 2) BM. Comparative analysis of Foci 1 and Foci 2 revealed significantly weaker treatment responses in non-enhanced lesions (Patients 7-8), with Patient 5 exhibiting disease progression without any response. This study demonstrates that, following standardized treatment protocols aligned with clinical guidelines, the therapeutic effect of non-enhanced lung cancer BM is inferior to that of enhanced BM. Evaluating the enhancement type of lung cancer BM is essential for efficacy prediction and holds important implications for treatment guidance.
脑转移瘤（BM）是最常见的颅内恶性肿瘤。约30%-40%的癌症患者在疾病的某个阶段会发生脑转移瘤，其发病率高且预后较差。我们的临床研究结果表明，非强化型和强化型肺癌脑转移瘤在疗效上存在显著差异。因此，本研究的目的是对非强化型肺癌脑转移瘤的治疗效果进行纵向磁共振成像（MRI）评估，从而实现更准确的疗效预测和更个性化的治疗方案。我们对72例肺癌脑转移瘤患者的临床和影像数据进行了回顾性分析。排除标准包括有原发性脑肿瘤、其他恶性肿瘤病史或神经系统症状的参与者。我们对8例符合入选标准的非强化型脑转移瘤患者进行了纵向MRI评估。使用神经肿瘤反应评估标准（RANO 2.0）对全身治疗的反应进行局部评估。本研究共纳入8例患者，其中4例为非强化型脑转移瘤，4例同时具有强化型和非强化型脑转移瘤。非强化型脑转移瘤的中位随访时间为19个月，疾病控制率为50%。相比之下，强化型脑转移瘤的中位无进展随访时间为35.5个月，疾病控制率为100%。按照临床指南进行标准化治疗后，强化型脑转移瘤患者的治疗效果明显优于非强化型脑转移瘤患者。病例1-4表现为非强化型或轻度环形强化型肺癌脑转移瘤，所有4个病灶在大约一年内大小均增加超过60%，表明疾病进展。在病例5-8中，每位患者有两个病灶：强化型（病灶1）和非强化型（病灶2）脑转移瘤。对病灶1和病灶2的对比分析显示，非强化型病灶（患者7-8）的治疗反应明显较弱，患者5出现疾病进展且无任何反应。本研究表明，按照与临床指南一致的标准化治疗方案进行治疗后，非强化型肺癌脑转移瘤的治疗效果不如强化型脑转移瘤。评估肺癌脑转移瘤的强化类型对于疗效预测至关重要，对治疗指导具有重要意义。
