Ramakrishna Naren, Margolin Kim A
From the MD Anderson Cancer Center Orlando, University of Central Florida College of Medicine, Orlando FL; University of Washington Fred Hutchinson Cancer Research Center, Seattle, WA.
Am Soc Clin Oncol Educ Book. 2013:399-403. doi: 10.14694/EdBook_AM.2013.33.399.
The overall treatment paradigm for melanoma brain metastases continues to evolve and reflects the relative radioresistance of this histology, as well as the effect of emerging systemic therapies with central nervous system (CNS) activity. Local therapies, including surgery, whole brain radiotherapy (WBRT), and stereotactic radiosurgery (SRS), play an important role in the multidisciplinary management of melanoma brain metastases. Treatment selection for local therapies must consider many factors: (1) size, number, and location of lesions, (2) presence or absence of neurological symptoms, (3) extracranial disease status, expected survival, age, and performance status, (4) prior treatment history, (5) expected treatment toxicities, and (6) predicted response to systemic therapies. The choice of treatment modalities for brain metastases is among the most controversial areas in oncology. There has been a trend toward reduced use of WBRT and increased reliance on SRS and surgery for melanoma brain metastases. Although no prospective randomized data exist comparing local therapies for melanoma brain metastases, several large retrospective studies suggest aggressive local treatment with modalities including surgery and SRS are associated with favorable outcomes in select patients. Multidisciplinary collaboration is required to facilitate a treatment plan that balances reduction in risk of neurological death and symptomatic progression against the risk of treatment-related toxicity.
黑色素瘤脑转移的整体治疗模式不断演变，反映了这种组织学类型相对的放射抗性，以及具有中枢神经系统（CNS）活性的新兴全身疗法的效果。局部治疗，包括手术、全脑放疗（WBRT）和立体定向放射外科（SRS），在黑色素瘤脑转移的多学科管理中发挥着重要作用。局部治疗的治疗选择必须考虑许多因素：（1）病变的大小、数量和位置，（2）是否存在神经症状，（3）颅外疾病状态、预期生存期、年龄和体能状态，（4）既往治疗史，（5）预期的治疗毒性，以及（6）对全身疗法的预测反应。脑转移治疗方式的选择是肿瘤学中最具争议的领域之一。对于黑色素瘤脑转移，存在减少使用WBRT并增加对SRS和手术的依赖的趋势。虽然没有前瞻性随机数据比较黑色素瘤脑转移的局部治疗，但几项大型回顾性研究表明，采用包括手术和SRS在内的积极局部治疗在部分患者中与良好的预后相关。需要多学科协作来制定一个平衡神经死亡风险和症状进展风险与治疗相关毒性风险的治疗计划。
