立体定向放射外科治疗非小细胞肺癌脑转移瘤的挑战与进展

doi:10.19854/j.cnki.1008-2425.2023.06.0011

摘要/Abstract

摘要： 非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移约占全部脑转移瘤的40%~55%,约10%的NSCLC患者在确诊时已发生脑转移,严重影响患者预后和生活质量。另一方面,更精准的局部放疗在不断深入探索,以求在最大限度保证患者生活质量的前提下,不断延长生存期。在之前的研究中表明,立体定向放射外科(stereotactic radiosurgery,SRS)作为一种微创且有效的治疗方式,在提高脑转移瘤的局部控制率(local controlrate,LCR)的同时减少了神经认知功能损伤。另外,危及器官(organsatrisk,OAR)附近的转移瘤使用SRS较手术有更低的风险和更少的副作用。最近研究发现,在体积稍大的脑转移瘤治疗中分段自适应SRS和大分割立体定向放射外科(hypofractionated stereotactic radiosurgery,HF-SRS)表现出高的LCR和低放射性坏死(radiation necrosis,RN)率,同时HF-SRS对体积较小的脑转移瘤同样有着高的LCR。本文介绍了非小细胞肺癌脑转移瘤主流治疗方式中SRS同全脑放疗(whole brain radiotherapy,WBRT)及手术的对比,HF-SRS、分段自适应SRS、术前或术后SRS及立体定向放疗联合靶向或免疫治疗的进展及挑战。

中图分类号:

R739.41

周占元, 张国荣. 立体定向放射外科治疗非小细胞肺癌脑转移瘤的挑战与进展[J]. 立体定向和功能性神经外科杂志, 2023, 36(6): 376-381.

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