Department of Human Oncology and Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, USA.
Am J Clin Oncol. 2010 Aug;33(4):398-407. doi: 10.1097/COC.0b013e318194f744.
Each year approximately 170,000 patients are diagnosed with brain metastasis in the United States, making this the most common intracranial tumor in adults. Historically, treatment strategies focused on the use of whole brain radiation therapy (WBRT) for palliation, yielding a median survival time of only 3 to 6 months. The possible effect of WBRT on cognitive function has generated much concern and debate regarding the use of this modality. Thus, the use of WBRT alone, or in conjunction with other treatment modalities should take into account both risks and benefits, to ensure the best patient outcome with regard to disease state and functional status. The advent of technologies permitting local dose-escalation have clearly increased local control rates, and in select patients, even survival, thereby, further intensifying the debate regarding the use of WBRT. Here, we review the use of WBRT, radiosurgery, and resection for the treatment of brain metastases. Further, we will review the use of radiation sensitizers and blood-brain barrier penetrating cytotoxics such as temozolomide. Finally, we will discuss current treatment strategies for possibly maintaining and improving cognitive function for these patients.
每年大约有 17 万名患者在美国被诊断出患有脑转移瘤，这使其成为成年人中最常见的颅内肿瘤。历史上，治疗策略侧重于使用全脑放射治疗（WBRT）来缓解症状，中位生存时间仅为 3 至 6 个月。WBRT 对认知功能的可能影响引起了人们对使用这种方法的极大关注和争议。因此，单独使用 WBRT 或与其他治疗方式联合使用应考虑到风险和益处，以确保在疾病状态和功能状态方面为患者带来最佳结果。允许局部剂量递增的技术的出现，显然提高了局部控制率，在某些患者中甚至提高了生存率，从而进一步加剧了关于 WBRT 使用的争论。在这里，我们回顾了 WBRT、放射外科和切除术治疗脑转移瘤的应用。此外，我们将回顾辐射增敏剂和血脑屏障穿透细胞毒素如替莫唑胺的使用。最后，我们将讨论目前可能维持和改善这些患者认知功能的治疗策略。
