Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Toronto, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2012 Aug;24(6):e81-92. doi: 10.1016/j.clon.2012.03.008.
To evaluate international patterns of practice for the management of metastatic disease to the brain.
An online international practice survey was conducted from April to June 2010. Most of the survey questions were based on common management issues for which optimal management using level 1 evidence was lacking. The survey consisted of three sections: respondent demographics, 13 general questions regarding surgery, whole brain radiotherapy (WBRT) and radiosurgery and 13 questions related to specific scenarios.
In total, 445 individuals responded to the survey over a 3 month period. Ninety per cent of respondents worked in a hospital-based setting. Ninety-three per cent of respondents were radiation oncologists. Thirty-seven per cent worked in an academic setting. Only three of 26 survey questions generated at least 70% agreement for a favoured response. Eighty-eight per cent of respondents chose comfort measures only for patients with multiple brain metastases who have been previously treated with WBRT and who now present 6 months later with two to four brain metastases (all less than 4 cm in size) with uncontrolled extracranial disease and bedridden state. Seventy-eight per cent of respondents would use WBRT alone for initial treatment in patients with two to four brain metastases (all less than 4 cm in size), with active, uncontrolled extracranial disease and a Karnofsky performance status of 70. Seventy-eight per cent of respondents chose surgical resection for an enlarging single brain metastasis that has been previously treated with radiosurgery. The enlarging single brain metastasis is in a surgically accessible site and is now symptomatic. The patient has controlled extracranial disease, good performance status and magnetic resonance spectroscopy was not diagnostic.
There is a lack of uniform agreement for many common management issues (not well answered by level 1 evidence) in patients with metastatic disease to the brain.
评估治疗脑转移瘤的国际实践模式。
2010 年 4 月至 6 月进行了一项在线国际实践调查。大多数调查问题都是基于常见的管理问题，这些问题缺乏 1 级证据的最佳管理。该调查包括三个部分：受访者人口统计学资料、13 个关于手术、全脑放疗（WBRT）和放射外科的一般问题以及 13 个与特定情况相关的问题。
在 3 个月的时间内，共有 445 人对调查做出了回应。90%的受访者在医院工作。93%的受访者是放射肿瘤学家。37%的人在学术环境中工作。在 26 个调查问题中，只有 3 个问题的回答得到了至少 70%的一致性支持。对于已经接受过 WBRT 治疗且现在出现 6 个月后有 2 至 4 个脑转移灶（所有大小均小于 4cm）、伴有未控制的颅外疾病和卧床状态的多发性脑转移患者，88%的受访者选择仅采用舒适治疗措施。78%的受访者将在有 2 至 4 个脑转移灶（所有大小均小于 4cm）、有活跃的、未控制的颅外疾病和 Karnofsky 表现状态为 70 的患者中单独使用 WBRT 进行初始治疗。78%的受访者选择手术切除以前接受过放射外科治疗的单个脑转移灶增大。增大的单个脑转移灶位于可手术部位，现在出现症状。患者有控制的颅外疾病，表现状态良好，磁共振波谱检查无诊断意义。
对于脑转移瘤患者的许多常见管理问题（无法通过 1 级证据很好地回答），缺乏一致的共识。
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