Klos Kevin J, O'Neill Brian Patrick
Department of Mayo Clinic, Rochester, MN, USA.
Neurologist. 2004 Jan;10(1):31-46. doi: 10.1097/01.nrl.0000106922.83090.71.
Systemic cancer is the second most common cause of death for adults in the United States. Twenty percent of these patients develop neurologic symptoms sometime during their illness. An apparent increase in the incidence of both systemic cancers and resulting brain metastases are posing an increasing challenge to health care providers. Neurologic complications lead to significant morbidity and mortality in these patients. Therefore, it is important to understand the current concepts of diagnosis and treatment of patients with brain metastases.
This review summarizes the epidemiology, clinical features, pathophysiology, and diagnostic evaluation of brain metastases. The section on current treatments is presented from the perspective of the three most common primary tumor locations along with the treatment approach to other metastatic tumors. This review includes a thorough evaluation of the literature, highlights controversies over treatment options, and provides insight into novel approaches currently under investigation. Clinical studies needed for further study are also discussed.
A clearer understanding of the pathophysiology of metastatic tumors and advances in diagnostic technology have paved the road to a better approach to treatment of brain metastases. Although no curative treatments are available to date, significant improvement in a patient's quality of life and life expectancy can be achieved with the available therapy. A better understanding of different primary cancers leading to brain metastases leads to a more effective treatment. More studies are needed to critically analyze the clear benefit of these treatment options in selected patients.
在美国，系统性癌症是成年人第二大常见死因。这些患者中有20%在患病期间的某个时候会出现神经系统症状。系统性癌症及其所致脑转移瘤的发病率明显上升，给医疗服务提供者带来了越来越大的挑战。神经系统并发症会导致这些患者出现显著的发病率和死亡率。因此，了解脑转移瘤患者目前的诊断和治疗理念很重要。
本综述总结了脑转移瘤的流行病学、临床特征、病理生理学及诊断评估。当前治疗部分从三个最常见的原发肿瘤部位的角度进行阐述，并介绍了其他转移性肿瘤的治疗方法。本综述全面评估了文献，突出了治疗选择方面的争议，并深入探讨了目前正在研究的新方法。还讨论了进一步研究所需的临床研究。
对转移性肿瘤病理生理学的更清晰理解以及诊断技术的进步为更好地治疗脑转移瘤铺平了道路。尽管目前尚无治愈性治疗方法，但现有治疗可显著提高患者的生活质量和预期寿命。对导致脑转移瘤的不同原发癌症有更深入的了解有助于更有效地进行治疗。需要更多研究来严格分析这些治疗选择在特定患者中的明确益处。
