肺腺癌脑转移立体定向放疗联合免疫治疗后假性进展1例报道并文献复习

Pseudoprogression after stereotactic radiotherapy combined with immunotherapy for brain metastasis of lung adenocarcinoma:a case report and review of literatures

放疗不仅可控制照射区原发肿瘤增殖,同时也能促进肿瘤组织释放抗原形成原位灭活疫苗增加免疫治疗疗效,但放疗与免疫治疗的结合也对疗效评价提出了新挑战。本文报道了1例老年驱动基因阴性肺腺癌孤立性脑转移病例。患者在脑部立体定向放疗联合免疫治疗1个月后即出现脑、肝脏、肾上腺部位新发病变,而肺部原发病灶缩小。在随后复查中确定新发病变为假性进展。这一病例提示脑转移患者立体定向放疗联合免疫治疗具有良好的疗效且不良反应轻微。

Radiotherapy can not only control the proliferation of primary tumors in the irradiation area,but also promote the release of antigens in tumor tissue to form in situ inactivated vaccines to increase the efficacy of immunotherapy,and the combination of radiotherapy and immunotherapy also possesses a new challenge to the evaluation of efficacy.This paper reported a case of isolated brain metastases in driver-gene negative lung adenocarcinoma.The patient developed new lesions in brain,liver,and adrenal glands after one month of stereotactic radiotherapy combined with immunotherapy,and the primary lesion in the lung was reduced.Subsequent review confirmed that the new onset was pseudo-progression.This case suggested that stereotactic radiotherapy plus immunotherapy in patients with brain metastases may has good efficacy and mild side effects.