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背景与目的间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)阳性非小细胞肺癌(non-small cell lung cancer,NSCLC)是肺癌的一个重要亚型。ALK阳性NSCLC脑转移患者的治疗尚无标准模式。方法本研究对我院2013年3月-2016年3月期间确诊的ALK阳性NSCLC脑转移患者的临床资料和治疗情况进行回顾性分析,探讨不同治疗模式患者的转归。结果 84例晚期ALK阳性NSCLC患者中,22例初诊时有脑转移,剔除3例合并表皮生长因子受体(epidermal growth factor receptor,EGFR)双突变患者,共19例纳入分析。中位颅内疾病进展时间(progression-free survival,PFS)为12.0个月,一线脑部局部治疗(P=0.021)及一线克唑替尼治疗(P=0.030)可延长PFS;一线克唑替尼联合脑部局部治疗的中位颅内PFS为27.0个月,而单纯克唑替尼治疗的PFS仅为4.2个月。结论一线克唑替尼联合脑部局部治疗有助于延长ALK阳性晚期NSCLC患者的颅内PFS,因例数少,尚有待大样本多中心前瞻性临床研究证实。
Background and Objectives Anaplastic lymphoma kinase (ALK) -positive non-small cell lung cancer (NSCLC) is an important subtype of lung cancer. There is no standard model for the treatment of patients with ALK-positive NSCLC brain metastases. Methods This study retrospectively analyzed the clinical data and treatment of ALK-positive NSCLC patients with brain metastases from March 2013 to March 2016 in our hospital and explored the outcomes of patients with different treatment modalities. Results Of the 84 patients with advanced NSCLC with ALK, 22 had brain metastases at the time of first visit, and 3 patients with double mutations of epidermal growth factor receptor (EGFR) were excluded. A total of 19 patients were included in the analysis. The median progression-free survival (PFS) was 12.0 months, with first-line brain topical (P = 0.021) and first-line crizotinib treatment (P = 0.030) The median intracranial PFS for subcutaneous treatment in the combined naïve brain was 27.0 months compared to 4.2 months for crizotinib alone. Conclusions The first-line crizotinib combined with topical brain treatment may help to prolong the intracranial PFS in ALK-positive advanced NSCLC patients due to the small number of cases yet to be confirmed by a large multicenter prospective clinical study.