title: [Crizotinib Treatment Combined with Resection and Whole-brain Radiation Therapy  in A ROS1 Rearranged Lung Adenocarcinoma with Brain Metastasis:  Case Report and Literature Review].
abstract: BACKGROUND
  Lung cancer with brain metastasis had poor prognosis. Crizotinib had been confirmed to be used in ROS1 (C-ros oncogene 1 receptor tyrosine kinase) rearranged lung adenocarcinoma, but its efficacy in lung cancer with brain metastasis was poor due to the blood brain barrier. In the present study, we reported one case of ROS1 fusion lung adenocarcinoma with symptomatic brain matastasis, who was treated with brain metastases resection, crizotinib, and whole brain radiotherapy plus boost to residual brain metastasis. The safety and efficacy was summarized.
  
  
  METHODS
  At first, surgical resection was used to relive mass effect and to biopsy. Then crizotinib (250 mg, bid) was chosen for the existence of ROS1 fusion gene. Whole brain radiotherapy plus boost to residual brain metastasis were used after surgery. Objective response was evaluated by Response Evaluation Criteriation in Solid Tumours (RECIST) v1.1 and brain metastasis were evaluated by computer tomography (CT)/magnetic resonance imaging (MRI) image. Adverse events were evaluated according to Common Terminology Criteria for Adverse Events (CTC AE) v4.0.
  
  
  RESULTS
  After taking crizotinib for 3 months, the lung lesions were close to complete response (CR), the brain metastasis were partial response (PR), the abdomen metastasis were CR and the symptom of blurred vision relieved.
  
  
  CONCLUSIONS
  Crizotinib combined with palliative operation and radiation therapy (WBRT plus boost to residual brain metastasis) in the treatment of ROS1 fusion gene positive lung adenocarcinoma with symptomatic brain metastases, can effectively control intracranial lesions with good tolerance.
authors: Department of Radiation Therapy,  Peking University First Hospital, Beijing 100034, China.
authors: Min
authors: M
authors: Zhang
authors: Department of Pulmonary and Critical Care Medicine,  Peking University First Hospital, Beijing 100034, China.
authors: Ligong
authors: L
authors: Nie
authors: Department of Neurosurgery,  Peking University First Hospital, Beijing 100034, China.
authors: Jiayong
authors: J
authors: Zhang
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics* / Q000473:pathology*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D000077547:Crizotinib; D005260:Female; D015321:Gene Rearrangement; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics* / Q000473:pathology*; D011505:Protein-Tyrosine Kinases / Q000235:genetics*; D011518:Proto-Oncogene Proteins / Q000235:genetics*; D011720:Pyrazoles / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011725:Pyridines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D012449:Safety; D016896:Treatment Outcome
chemical_list: D011518:Proto-Oncogene Proteins; D011720:Pyrazoles; D011725:Pyridines; D000077547:Crizotinib; D011505:Protein-Tyrosine Kinases; C062333:ROS1 protein, human