Abstract：
Although tyrosine kinase inhibitors (TKI) have revolutionized the treatment of anaplastic lymphoma kinase rearranged non-small cell lung cancer (ALKr-NSCLC), radiotherapy (RT) still plays an essential role for treatment of both intracranial and extracranial metastases, particularly for patients experienced a TKI-failure. We reported the case of a 38-year-old woman with metastatic ALKr-NSCLC who received whole-brain radiotherapy (RT) for multiple brain metastases (BMs), initially. After RT, alectinib was initiated and the patient had a good clinico-radiological response in both intracranial and extracranial regions. However, intracranial progression was developed and, stereotactic radiosurgery (SRS) was applied to the four progressed BMs. Two months after SRS, all BMs disappeared. While patient was using alectinib, a recurrent lung lesion, a hilar lymph node and bone metastasis were detected. Stereotactic body radiotherapy (SBRT) was applied to all metastatic sites and, alectinib was continued again. Three months after SBRT, a complete response was obtained. She has been alive with the initial systemic therapy agent for more than 4years without evidence of neither disease nor toxicity. SRS/SBRT may eradicate the TKI-resistant tumoral clones and it may prevent switching the systemic therapy, even if there is a failure.
摘要：
尽管酪氨酸激酶抑制剂（TKI）彻底改变了间变性淋巴瘤激酶重排的非小细胞肺癌（ALKr-NSCLC）的治疗，放疗（RT）在颅内和颅外转移瘤的治疗中仍然起着至关重要的作用，特别是对于经历了TKI失败的患者。我们报道了一名38岁的转移性ALKr-NSCLC女性患者，因多发性脑转移（BMs）接受全脑放疗（RT），最初。RT之后,阿来替尼开始治疗,患者在颅内和颅外区域均有良好的临床放射学反应.然而,颅内进展发展，立体定向放射外科（SRS）应用于四个进展的BM。SRS后两个月，所有BMS都消失了。当患者使用阿来替尼时，反复发作的肺部病变,发现肺门淋巴结和骨转移。立体定向放射治疗（SBRT）应用于所有转移部位，阿莱替尼再次继续治疗.SBRT之后三个月,获得了完整的响应。她在最初的全身治疗药物中存活了4年以上，既没有疾病也没有毒性的证据。SRS/SBRT可以根除TKI抗性肿瘤克隆，并且可以阻止系统治疗的转换，即使有失败。
