Brain metastases (BMs) represent the most frequent metastatic event in the course of lung cancer patients, occurring in approximately 50% of patients with non-small-cell lung cancer (NSCLC) and in up to 70% in patients with small-cell lung cancer (SCLC). Thus far, many advances have been made in the diagnostic and therapeutic procedures, allowing improvements in the prognosis of these patients. The modern approach relies on the integration of several factors, such as accurate histological and molecular profiling, comprehensive assessment of clinical parameters and precise definition of the extent of intracranial and extracranial disease involvement. The combination of these factors is pivotal to guide the multidisciplinary discussion and to offer the most appropriate treatment to these patients based on a personalized approach. Focal radiotherapy (RT), in all its modalities (radiosurgery (SRS), fractionated stereotactic radiotherapy (SRT), adjuvant stereotactic radiotherapy (aSRT)), is the cornerstone of BM management, either alone or in combination with surgery and systemic therapies. We review the modern therapeutic strategies available to treat lung cancer patients with brain involvement. This includes an accurate review of the different technical solutions which can be exploited to provide a “state-of-art” focal RT and also a detailed description of the systemic agents available as effective alternatives to SRS/SRT when a targetable molecular driver is present. In addition to the validated treatment options, we also discuss the future perspective for focal RT, based on emerging clinical reports (e.g., SRS for patients with many BMs from NSCLC or SRS for BMs from SCLC), together with a presentation of innovative and promising findings in translational research and the combination of novel targeted agents with SRS/SRT.
脑转移是肺癌病程中最常见的转移事件，约50%的非小细胞肺癌患者及高达70%的小细胞肺癌患者会发生脑转移。迄今为止，诊断与治疗手段已取得诸多进展，显著改善了这类患者的预后。现代诊疗策略依赖于多因素整合，包括精确的组织学和分子分型、临床参数的综合评估，以及颅内与颅外病变范围的精确定义。这些因素的结合对于指导多学科讨论、基于个体化方案为患者提供最适宜治疗至关重要。在所有治疗模式中，局灶性放疗（包括立体定向放射外科、分次立体定向放疗、辅助立体定向放疗）是脑转移治疗的基石，既可单独应用，也可与手术及全身治疗联合使用。本文综述了当前针对伴脑转移肺癌患者的治疗策略，系统梳理了实现"前沿水平"局灶性放疗的不同技术方案，并详细阐述了当存在可靶向分子驱动基因时，可作为立体定向放疗有效替代方案的全身治疗药物。除已验证的治疗方案外，本文还基于新兴临床报告（如针对非小细胞肺癌多发脑转移或小细胞肺癌脑转移的立体定向放射外科治疗），探讨了局灶性放疗的未来发展方向，同时介绍了转化医学研究中具有创新性和前景的发现，以及新型靶向药物与立体定向放疗的联合应用策略。
肿瘤(癌症)患者之家