Abstract
Non-small cell lung cancer (NSCLC) is one of the most common malignant tumors and has high morbidity and mortality rates. Central nervous system (CNS) metastasis is one of the most frequent complications in patients with NSCLC and seriously affects the quality of life (QOL) and overall survival (OS) of patients, with a median OS of untreated patients of only 1–3 months. There are various treatment methods for NSCLC CNS metastasis, including surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy, which do not meet the requirements of patients in terms of improving OS and QOL. There are still many problems in the treatment of NSCLC CNS metastasis that need to be solved urgently. This review summarizes the research progress in the treatment of NSCLC CNS metastasis to provide a reference for clinical practice.
Highlights
Treatment of Central Nervous SystemLung cancer ranks first in terms of morbidity and mortality among all tumors worldwide, and non-small cell lung cancer (NSCLC) is the most common type of lung cancer [1].The central nervous system (CNS) is a common clinical site for metastasis of NSCLC, which seriously affects the prognosis and quality of life (QOL) of patients
leptomeningeal metastasis (LM) refers to the spread of malignant tumor cells through the cerebrospinal fluid (CSF) to the leptomeninges, which is a rare event with an incidence of only 3–5% in patients with NSCLC
tyrosine kinase inhibitor (TKI), such as epidermal growth factor receptor (EGFR)-TKIs and anaplastic lymphoma kinase (ALK)-TKIs, that target NSCLC driver mutations have greatly improved the prognosis of patients with NSCLC CNS metastasis with the corresponding gene mutations
Summary
Lung cancer ranks first in terms of morbidity and mortality among all tumors worldwide, and non-small cell lung cancer (NSCLC) is the most common type of lung cancer [1]. The prognosis of patients with NSCLC LM metastasis is poor, with overall survival (OS) of 3 months with contemporary treatment and less than 11 months with novel therapies [6]. Available treatment options for NSCLC CNS metastasis include surgery, radiotherapy, chemotherapy, immunotherapy, and targeted therapy (Figure 1). Patients with NSCLC CNS metastasis treated with wholebrain radiotherapy (WBRT) alone generally have a poor prognosis with a median survival of less than 6 months [16]. Patients with NSCLC CNS metastasis harboring EGFR mutations have a great response to EGFR tyrosine kinase inhibitor (TKI) treatment with RRs of 60–80% (OS 15–20 months) [20,21]. NSCLC CNS metastasis have a dramatic response to ALK-TKI treatment with RRs of 36–72%. This article reviews the treatment progress and prognostic factors associated with NSCLC CNS metastasis
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