Lohr F, Pirzkall A, Hof H, Fleckenstein K, Debus J
Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany. frank
Semin Surg Oncol. 2001 Jan-Feb;20(1):50-6. doi: 10.1002/ssu.1016.
With an incidence of 15/10(5) in the general population, brain metastases constitute a serious, debilitating complication in cancer patients. The majority of those patients suffer from more than one metastasis, but up to 30% to 40% present with a solitary lesion. Whole-brain radiotherapy (WBRT) extends median survival from 1 to 2 months for treatment with steroids only, to 4 to 6 months in most series. However, long-term survival (>1-2 years) is observed in up to 10% of patients with favorable prognostic factors, such as solitary lesions, good Karnofsky performance status, and absence of extracranial disease. For those patients, individually optimized treatment is worthwhile. For good-prognosis patients with controlled extracranial disease, surgery in combination with postoperative WBRT should be considered, especially when fast relief of symptoms is mandated. For surgically inaccessible solitary lesions below a size threshold of approximately 30 ccm, stereotactic radiosurgery (RS), although never compared to surgery in a randomized fashion, seems to yield comparable results and is the treatment of choice for more than one lesion in appropriately selected patients. Nevertheless, a number of questions concerning the optimal treatment regimens for brain metastases remain. These mainly concern the radiation dose, need for a combination of RS and WBRT, relative timing of different treatment modalities, and maximum number of brain metastases that can reasonably be treated with RS when long-term progression-free survival is the goal. However, RS is definitely an excellent option for salvage and palliation in patients with short life expectancy, as it is simultaneously noninvasive and cost-effective, with short hospitalization times.
脑转移瘤在普通人群中的发病率为15/10(5)，是癌症患者严重的、使人衰弱的并发症。这些患者中的大多数有不止一处转移瘤，但高达30%至40%的患者表现为单个病灶。全脑放疗（WBRT）可将仅用类固醇治疗的中位生存期从1至2个月延长至大多数系列报道中的4至6个月。然而，在高达10%具有有利预后因素的患者中可观察到长期生存（>1至2年），这些因素包括单个病灶、良好的卡氏功能状态以及无颅外疾病。对于这些患者，个体化的优化治疗是值得的。对于颅外疾病得到控制的预后良好的患者，应考虑手术联合术后WBRT，尤其是在需要快速缓解症状时。对于直径小于约30立方厘米且手术无法触及的单个病灶，立体定向放射外科（RS）虽然从未与手术进行过随机对照比较，但似乎能产生类似的效果，并且是适当选择的有多个病灶患者的首选治疗方法。然而，关于脑转移瘤的最佳治疗方案仍有一些问题。这些问题主要涉及放射剂量、RS与WBRT联合使用的必要性、不同治疗方式的相对时机，以及以长期无进展生存为目标时RS能合理治疗的脑转移瘤最大数量。然而，RS绝对是预期寿命短的患者进行挽救和姑息治疗的极佳选择，因为它同时具有非侵入性、成本效益高且住院时间短的特点。
