Baschnagel Andrew, Wolters Pamela L, Camphausen Kevin
Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10-CRC, Room B2-3561, Bethesda, Maryland, 20892, USA.
Radiat Oncol. 2008 Sep 17;3:26. doi: 10.1186/1748-717X-3-26.
Prognosis for patients with brain metastasis remains poor. Whole brain radiation therapy is the conventional treatment option; it can improve neurological symptoms, prevent and improve tumor associated neurocognitive decline, and prevents death from neurologic causes. In addition to whole brain radiation therapy, stereotactic radiosurgery, neurosurgery and chemotherapy also are used in the management of brain metastases. Radiosensitizers are now currently being investigated as potential treatment options. All of these treatment modalities carry a risk of central nervous system (CNS) toxicity that can lead to neurocognitive impairment in long term survivors. Neuropsychological testing and biomarkers are potential ways of measuring and better understanding CNS toxicity. These tools may help optimize current therapies and develop new treatments for these patients. This article will review the current management of brain metastases, summarize the data on the CNS effects associated with brain metastases and whole brain radiation therapy in these patients, discuss the use of neuropsychological tests as outcome measures in clinical trials evaluating treatments for brain metastases, and give an overview of the potential of biomarker development in brain metastases research.
脑转移患者的预后仍然很差。全脑放射治疗是传统的治疗选择；它可以改善神经症状，预防和改善肿瘤相关的神经认知功能下降，并预防因神经原因导致的死亡。除了全脑放射治疗外，立体定向放射外科、神经外科和化疗也用于脑转移瘤的治疗。放射增敏剂目前正在作为潜在的治疗选择进行研究。所有这些治疗方式都有中枢神经系统（CNS）毒性的风险，这可能导致长期存活者出现神经认知障碍。神经心理学测试和生物标志物是测量和更好地理解CNS毒性的潜在方法。这些工具可能有助于优化当前的治疗方法，并为这些患者开发新的治疗方法。本文将回顾脑转移瘤的当前治疗方法，总结这些患者中与脑转移瘤和全脑放射治疗相关的CNS效应的数据，讨论在评估脑转移瘤治疗的临床试验中使用神经心理学测试作为结果指标，并概述脑转移瘤研究中生物标志物开发的潜力。
