Department of Radiation Oncology, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia,
Curr Treat Options Oncol. 2013 Dec;14(4):553-67. doi: 10.1007/s11864-013-0258-0.
Brain metastases occur in 20-40 % of lung cancer patients. The use of whole brain radiation therapy (WBRT) has been shown to ameliorate many neurological symptoms, facilitate corticosteroid reduction, enhance quality of life (QOL), and prolong survival. The acute and early delayed side effects of WBRT are generally mild and inconsequential, whereas late complications often are progressive, irreversible, and may have a profound effect on neurocognitive function and QOL. Nevertheless, WBRT remains the cornerstone for treatment of multiple brain metastases due to its efficacy and the paucity of other treatment options. In avoidance of WBRT and its potential toxicity, patients of good performance status and ≤3 metastases may be treated reasonably with focal therapy alone (surgery or radiosurgery) without a compromise in survival. In patients with multiple brain metastases and those undergoing prophylactic cranial irradiation (PCI), established methods to mitigate the late complications of WBRT include total dose observation, dose per fraction restrictions, and avoidance of concomitant chemotherapy. Current areas of active research that hold great potential for benefit include hippocampal-sparing radiotherapy and the use of neuroprotective agents.
脑转移发生在 20-40%的肺癌患者中。全脑放疗（WBRT）的应用已被证明可以改善许多神经症状，促进皮质类固醇的减少，提高生活质量（QOL）并延长生存时间。WBRT 的急性和早期迟发性副作用通常较轻且无足轻重，而晚期并发症常常是进行性的、不可逆的，并且可能对神经认知功能和 QOL 产生深远影响。然而，由于其疗效和其他治疗选择的缺乏，WBRT 仍然是治疗多发脑转移的基石。为了避免 WBRT 及其潜在毒性，对于一般状况良好且转移灶≤3 的患者，单独采用局部治疗（手术或放射外科）治疗即可，而不会影响生存时间。对于多发脑转移和预防性颅脑照射（PCI）的患者，减轻 WBRT 晚期并发症的既定方法包括观察总剂量、限制每次分割剂量以及避免同时进行化学疗法。目前正在积极研究的具有潜在益处的领域包括海马保护放疗和神经保护剂的使用。
