Owonikoko Taofeek K, Arbiser Jack, Zelnak Amelia, Shu Hui-Kuo G, Shim Hyunsuk, Robin Adam M, Kalkanis Steven N, Whitsett Timothy G, Salhia Bodour, Tran Nhan L, Ryken Timothy, Moore Michael K, Egan Kathleen M, Olson Jeffrey J
Department of Hematology and Medical Oncology, Emory University, Atlanta, GA 30322, USA.
Department of Dermatology, Atlanta Veterans Administration Medical Center, Emory University, Atlanta, GA 30322, USA.
Nat Rev Clin Oncol. 2014 Apr;11(4):203-22. doi: 10.1038/nrclinonc.2014.25. Epub 2014 Feb 25.
Metastatic tumours involving the brain overshadow primary brain neoplasms in frequency and are an important complication in the overall management of many cancers. Importantly, advances are being made in understanding the molecular biology underlying the initial development and eventual proliferation of brain metastases. Surgery and radiation remain the cornerstones of the therapy for symptomatic lesions; however, image-based guidance is improving surgical technique to maximize the preservation of normal tissue, while more sophisticated approaches to radiation therapy are being used to minimize the long-standing concerns over the toxicity of whole-brain radiation protocols used in the past. Furthermore, the burgeoning knowledge of tumour biology has facilitated the entry of systemically administered therapies into the clinic. Responses to these targeted interventions have ranged from substantial toxicity with no control of disease to periods of useful tumour control with no decrement in performance status of the treated individual. This experience enables recognition of the limits of targeted therapy, but has also informed methods to optimize this approach. This Review focuses on the clinically relevant molecular biology of brain metastases, and summarizes the current applications of these data to imaging, surgery, radiation therapy, cytotoxic chemotherapy and targeted therapy.
累及脑的转移性肿瘤在发生频率上超过原发性脑肿瘤，并且是许多癌症整体治疗中的重要并发症。重要的是，在理解脑转移瘤初始发展及最终增殖的分子生物学方面正在取得进展。手术和放疗仍然是有症状性病变治疗的基石；然而，基于影像的引导正在改进手术技术，以最大程度地保留正常组织，同时正在采用更先进的放疗方法，以尽量减少对过去使用的全脑放疗方案毒性的长期担忧。此外，肿瘤生物学知识的迅速增长促进了全身给药疗法进入临床。对这些靶向干预的反应范围从具有严重毒性且无法控制疾病到能有效控制肿瘤一段时间且不降低治疗个体的功能状态。这一经验使人们认识到靶向治疗的局限性，但也为优化这种方法提供了思路。本综述重点关注脑转移瘤的临床相关分子生物学，并总结这些数据在影像学、手术、放疗、细胞毒性化疗和靶向治疗中的当前应用。
