Nieder Carsten, Pawiniski Adam, Dalhaug Astrid
Department of Internal Medicine - Division of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodø, Norway.
BMC Res Notes. 2009 Dec 12;2:247. doi: 10.1186/1756-0500-2-247.
Controversy exists around the preferred management of patients with brain metastases and limited survival expectation, e.g. because of extensive brain involvement. Few studies have focused on this particular group of patients.
A group of 24 patients with a large number of brain metastases, defined as 10 or more on computed tomography scans, who were managed with palliative whole-brain radiotherapy (WBRT), typically 30 Gy in 10 fractions, were analyzed. The median number of lesions was 14. The patient characteristics were comparable to those of studies in the general population with brain metastases, except for the fact that all patients had active sites of extracranial disease. Clinical benefit, imaging response and overall survival were lower than expected. Median survival, for example was 2 months. Trends towards better survival were found in patients with brain metastases detected at first cancer diagnosis (synchronous manifestation, treatment naïve) and those with better prognostic features according to the graded prognostic assessment (GPA) score.
The benefit of WBRT did not meet the expectations, suggesting that consideration should be given to best supportive care including corticosteroid administration, especially if a patient belongs to the lowest GPA class.
对于脑转移且生存预期有限的患者，例如由于广泛脑受累，其最佳治疗方案存在争议。很少有研究关注这一特定患者群体。
分析了一组24例脑转移灶数量较多的患者，在计算机断层扫描上定义为10个或更多，这些患者接受姑息性全脑放疗（WBRT），通常为30 Gy分10次照射。病灶中位数为14个。患者特征与一般脑转移患者研究中的特征相似，不同之处在于所有患者都有颅外疾病的活跃部位。临床获益、影像学反应和总生存期均低于预期。例如，中位生存期为2个月。在首次癌症诊断时发现脑转移的患者（同步表现，未接受过治疗）以及根据分级预后评估（GPA）评分具有较好预后特征的患者中发现了生存改善趋势。
WBRT的获益未达预期，这表明应考虑给予包括使用皮质类固醇在内的最佳支持性治疗，特别是如果患者属于最低GPA等级。
