非小细胞肺癌脑转移的研究进展

Brain metastases of non-small cell lung cancer

非小细胞肺癌脑转移的治疗对肿瘤学家是一种挑战。虽然近年脑转移研究有所进展,但生存率并不乐观。本文阐述非小细胞肺癌脑转移的临床特点、诊断方法、预后因素以及治疗进展。脑转移最常见的症状为因颅内压力增高所致的头痛。评价脑转移时,头颅MRI较CT优越。最常用的预后标准是肿瘤放射治疗组(RTOG)的RPA分级。关于全脑放疗、立体定向放射外科、手术以及化疗治疗脑转移的作用仍存在争议。全脑放疗常作为脑转移的标准治疗方案。SRS对单一或多个脑转移灶的治疗可代替外科切除。许多数据证明化疗有较好的颅内作用,这引起全身化疗治疗脑转移的研究热点。确立预后因素和其他临床特点后,才能制定最适合个体患者的治疗。

Brain metastases of non-small cell lung cancer presents a challenge to oncologists. Despite the research developments during recent years, the survival rates remain poor. This article reviews the clinical manifestations, prognostic factors, and treatment strategies of brain metastases of non - small cell lung cancer. The most common symptom of brain metastases is headache due to increased intracranial pressure. The brain MRI is superior to computed tomography scanning in the evaluation of brain metastases. The most frequently used prognostic criteria is the recursive partitioning analysis （RPA） developed by the Radiation Therapy Oncology Group （RTOG）. Controversies exist regarding the roles of whole brain radiation therapy （WBRT）, stereotactic radiation surgery （SRS）, surgery, and initial therapy. WBRT has been the standard of care for the majority of patients with brain metastases. SRS has emerged as a possible alternative to surgical resection in patients with single and multiple brain metastases. Most data support good intracranial response to chemotherapy. These data have recently led to increased interests in the use of systemic agents in the treatment of brain metastases.