Ahluwalia Manmeet S, Vogelbaum Michael V, Chao Samuel T, Mehta Minesh M
Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH USA.
Department of Radiation Oncology, University of Maryland School of Medicine Baltimore, MD 21201 USA.
F1000Prime Rep. 2014 Dec 1;6:114. doi: 10.12703/P6-114. eCollection 2014.
Despite major therapeutic advances in the management of patients with systemic malignancies, management of brain metastases remains a significant challenge. These patients often require multidisciplinary care that includes surgical resection, radiation therapy, chemotherapy, and targeted therapies. Complex decisions about the sequencing of therapies to control extracranial and intracranial disease require input from neurosurgeons, radiation oncologists, and medical/neuro-oncologists. With advances in understanding of the biology of brain metastases, molecularly defined disease subsets and the advent of targeted therapy as well as immunotherapeutic agents offer promise. Future care of these patients will entail tailoring treatment based on host (performance status and age) and tumor (molecular cytogenetic characteristics, number of metastases, and extracranial disease status) factors. Considerable work involving preclinical models and better clinical trial designs that focus not only on effective control of tumor but also on quality of life and neurocognition needs to be done to improve the outcome of these patients.
尽管在系统性恶性肿瘤患者的治疗方面取得了重大进展，但脑转移瘤的治疗仍然是一项重大挑战。这些患者通常需要多学科护理，包括手术切除、放射治疗、化疗和靶向治疗。关于控制颅外和颅内疾病的治疗顺序的复杂决策需要神经外科医生、放射肿瘤学家以及医学/神经肿瘤学家的参与。随着对脑转移瘤生物学认识的进展，分子定义的疾病亚群以及靶向治疗和免疫治疗药物的出现带来了希望。这些患者未来的护理将需要根据宿主（体能状态和年龄）和肿瘤（分子细胞遗传学特征、转移灶数量和颅外疾病状态）因素来定制治疗方案。需要开展大量涉及临床前模型和更好的临床试验设计的工作，这些工作不仅要关注肿瘤的有效控制，还要关注生活质量和神经认知，以改善这些患者的治疗结果。
