Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
J Neurooncol. 2010 Jan;96(1):115-42. doi: 10.1007/s11060-009-0058-3. Epub 2009 Dec 3.
What evidence is available regarding the emerging and investigational therapies for the treatment of metastatic brain tumors?
These recommendations apply to adults with brain metastases.
New radiation sensitizers Level 2 A subgroup analysis of a large prospective randomized controlled trial (RCT) suggested a prolongation of time to neurological progression with the early use of motexafin-gadolinium (MGd). Nonetheless this was not borne out in the overall study population and therefore an unequivocal recommendation to use the currently available radiation sensitizers, motexafin-gadolinium and efaproxiral (RSR 13) cannot be provided. Interstitial modalities There is no evidence to support the routine use of new or existing interstitial radiation, interstitial chemotherapy and or other interstitial modalities outside of approved clinical trials. New chemotherapeutic agents Level 2 Treatment of melanoma brain metastases with whole brain radiation therapy and temozolomide is reasonable based on one class II study. Level 3 Depending on individual circumstances there may be patients who benefit from the use of temozolomide or fotemustine in the therapy of their brain metastases. Molecular targeted agents Level 3 The use of epidermal growth factor receptor inhibitors may be of use in the management of brain metastases from non-small cell lung carcinoma.
有哪些关于治疗转移性脑肿瘤的新兴和研究性治疗方法的证据？
这些建议适用于有脑转移的成年人。
新的辐射增敏剂 2A 级 一项大型前瞻性随机对照试验（RCT）的亚组分析表明，早期使用莫替沙芬钆（MGd）可延长神经进展时间。然而，这在整个研究人群中并未得到证实，因此不能明确推荐使用目前可用的辐射增敏剂，莫替沙芬钆和 efaproxiral（RSR 13）。 间质方式 没有证据支持常规使用新的或现有的间质辐射、间质化疗和/或其他间质方式，除非在批准的临床试验之外。 新的化疗药物 2 级 基于一项 II 类研究，脑转移瘤患者在接受全脑放疗和替莫唑胺治疗是合理的。 3 级 根据个体情况，可能有一些患者受益于替莫唑胺或 fotemustine 在脑转移瘤治疗中的应用。 分子靶向药物 3 级 表皮生长因子受体抑制剂的使用可能有助于治疗非小细胞肺癌的脑转移。
