Gijtenbeek J M M Anja, Ho Vincent K Y, Heesters M A A M Mart, Lagerwaard F J Frank, de Graeff Alexander, Boogerd Willem
Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands.
Ned Tijdschr Geneeskd. 2011;155(52):A4141.
Improved survival of cancer patients results in an increase in the incidence of brain metastases. In addition, asymptomatic brain metastases are more often detected as a consequence of active screening. In patients with cancer and new neurological symptoms, MRI of the brain is indicated to assess the presence and number of brain metastases. Decisions concerning treatment of brain metastases should take place within a multidisciplinary team. Treatment is in the first instance focused on improvement or preservation of neurological functioning. The main treatment options for patients with brain metastases are whole brain radiotherapy, stereotactic radiosurgery/radiotherapy, and neurosurgical resection. The choice of treatment depends on the number and the location of the brain metastases, the general and neurological condition of the patient, the extent of extracranial tumour activity, and the expected results of treatment. The revised guideline supports the policy of whole brain radiotherapy not being the standard treatment following stereotactic radiosurgery or radiotherapy. In the case of complete resection, confirmed using early postoperative MRI, whole brain radiotherapy does not add to survival benefit, while patients may suffer from radiation-induced toxicity.
癌症患者生存率的提高导致脑转移发生率上升。此外，由于积极筛查，无症状脑转移更常被检测出来。对于患有癌症且出现新的神经系统症状的患者，建议进行脑部MRI检查以评估脑转移的存在情况和数量。关于脑转移治疗的决策应在多学科团队内进行。治疗首先侧重于改善或保留神经功能。脑转移患者的主要治疗选择包括全脑放疗、立体定向放射外科/放疗和神经外科切除。治疗方法的选择取决于脑转移的数量和位置、患者的一般状况和神经状况、颅外肿瘤活动程度以及预期的治疗效果。修订后的指南支持在立体定向放射外科或放疗后，全脑放疗并非标准治疗方法的政策。在术后早期MRI证实完全切除的情况下，全脑放疗不会增加生存获益，而患者可能会遭受辐射诱导的毒性反应。
