Nguyen Teri, Deangelis Lisa M
Department of Neurology, Weill Medical College of Cornell University, New York, New York, USA.
J Support Oncol. 2004 Sep-Oct;2(5):405-10; discussion 411-6.
Brain metastases are a common complication of cancer, found in approximately 20% of patients at autopsy. The diagnosis is usually established by neuroimaging and carries a poor overall prognosis. Supportive therapies, such as corticosteroids, anticonvulsants, and anticoagulants, are necessary for most patients to address the common medical complications that often accompany brain metastases. These treatments often ameliorate symptoms and signs and improve neurologic function, but they require careful management to minimize their common toxicities. Definitive antitumor treatment may include whole-brain radiotherapy, surgery, stereotactic radiosurgery, and chemotherapy. A multimodal approach can yield prolonged survival of a year or more in some patients, particularly those with limited intracranial disease, high performance status, limited systemic cancer burden, young age, and certain tumor pathologies. However, even patients with poor prognostic factors can have some relief of neurologic symptoms and signs with the institution of therapy. Patients with recurrent brain metastases can also benefit from additional treatment, including all the modalities available at diagnosis.
脑转移瘤是癌症常见的并发症，尸检发现约20%的患者存在该情况。诊断通常通过神经影像学检查确定，总体预后较差。对于大多数患者而言，支持性治疗，如使用皮质类固醇、抗惊厥药和抗凝药，对于处理脑转移瘤常伴随的常见医学并发症是必要的。这些治疗通常可改善症状和体征并提高神经功能，但需要谨慎管理以将其常见毒性降至最低。确定性抗肿瘤治疗可能包括全脑放疗、手术、立体定向放射外科治疗和化疗。多模式治疗方法在某些患者中可使生存期延长一年或更长时间，尤其是那些颅内疾病局限、体能状态良好、全身癌症负担较轻、年龄较轻且具有某些肿瘤病理类型的患者。然而，即使是具有不良预后因素的患者，通过治疗也可使神经症状和体征得到一定缓解。复发性脑转移瘤患者也可从额外治疗中获益，包括诊断时可用的所有治疗方式。
