Dhakal Sughosh, Peterson Carl R, Milano Michael T
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY.
Am J Clin Oncol. 2014 Apr;37(2):208-14. doi: 10.1097/COC.0b013e3182546807.
Brain metastases are the most common form of intracranial tumor in adults and an increasingly important cause of morbidity and mortality. Rising incidence is attributed to advanced radiographic imaging and prolonged survival due to improvements in cancer therapy (including systemic therapies) that are not as effective in treating intracranial disease. Standard treatment options for brain metastases include resection, whole-brain radiation therapy (WBRT), stereotactic radiosurgery, or a combination of these modalities. Most patients with brain metastases receive some form of radiation therapy during the course of their illness, and for the majority of them, the prognosis is poor and WBRT remains the standard. However, within this very diverse patient population, subgroups exist in which prolonged survival is possible. In recent years, several randomized controlled trials have clearly demonstrated the efficacy of stereotactic radiosurgery in well-selected patients. This, along with an increased recognition of the late neurocognitive effects of WBRT, has led many to question the role of upfront WBRT in patients with limited intracranial metastases. In this review, we summarize the evolving role of radiotherapy in the management of brain metastases and then discuss the issues related to neurotoxicity from radiation and future areas of investigation.
脑转移瘤是成人颅内肿瘤最常见的形式，也是发病率和死亡率日益重要的原因。发病率上升归因于先进的影像学检查以及癌症治疗（包括全身治疗）的改善使患者生存期延长，而这些治疗对颅内疾病的疗效不佳。脑转移瘤的标准治疗选择包括手术切除、全脑放疗（WBRT）、立体定向放射外科治疗或这些方式的联合应用。大多数脑转移瘤患者在病程中会接受某种形式的放射治疗，而且对大多数患者来说，预后较差，WBRT仍然是标准治疗方法。然而，在这个非常多样化的患者群体中，存在一些有可能延长生存期的亚组。近年来，几项随机对照试验已清楚地证明了立体定向放射外科治疗对精心挑选的患者的疗效。这一点，再加上对WBRT晚期神经认知效应的认识增加，使得许多人质疑 upfront WBRT 在颅内转移瘤有限的患者中的作用。在本综述中，我们总结了放射治疗在脑转移瘤管理中不断演变的作用，然后讨论与放射神经毒性相关的问题以及未来的研究领域。
