Métellus P, Reyns N, Voirin J, Menei P, Bauchet L, Faillot T, Loiseau H, Pallud J, Guyotat J, Mandonnet E
Département de neurochirurgie, CHU La Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; Groupe de réflexion sur la prise en charge des métastases cérébrales (GRPCMaC), 13273 Marseille cedex 09, France; Centre de recherche en oncologie et onco-pharmacologie (CRO2), faculté de médecine Timone, université Aix-Marseille, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France; Inserm U911, faculté de médecine Timone, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France.
Département de neurochirurgie, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.
Cancer Radiother. 2015 Feb;19(1):20-4. doi: 10.1016/j.canrad.2014.11.007. Epub 2015 Jan 29.
Surgical excision of brain metastases has been well evaluated in unique metastases. Two randomized phase III trial have shown that combined with adjuvant whole brain radiotherapy, it significantly improves overall survival. However, even in the presence of multiple brain metastases, surgery may be useful. Also, even in lesions amenable to radiosurgery, surgical resection is preferred when tumors displayed cystic or necrotic aspect with important edema or when located in highly eloquent areas or cortico-subcortically. Furthermore, surgery may have a diagnostic role, in the absence of histological documentation of the primary disease, to rule out a differential diagnosis (brain abscess, lymphoma, primary tumor of the central nervous system or radionecrosis). Finally, the biological documentation of brain metastatic disease might be useful in situations where a specific targeted therapy can be proposed. Selection of patients who will really benefit from surgery should take into account three factors, clinical and functional status of the patient, systemic disease status and characteristics of intracranial metastases. Given the improved overall survival of cancer patients partially due to the advent of effective targeted therapies on systemic disease, a renewed interest has been given to the local treatment of brain metastases. Surgical resection currently represents a valuable tool in the armamentarium of brain metastases but has also become a diagnostic and decision tool that can affect therapeutic strategies in these patients.
脑转移瘤的手术切除在单发转移瘤中已得到充分评估。两项随机III期试验表明，与辅助全脑放疗联合使用时，它能显著提高总生存期。然而，即使存在多发脑转移瘤，手术也可能有用。此外，即使对于适合放射外科治疗的病灶，当肿瘤表现为伴有严重水肿的囊性或坏死性外观、位于功能区或皮质下区域时，手术切除仍是首选。此外，在缺乏原发疾病组织学证据的情况下，手术可能具有诊断作用，以排除鉴别诊断（脑脓肿、淋巴瘤、中枢神经系统原发性肿瘤或放射性坏死）。最后，在可以提出特定靶向治疗的情况下，脑转移瘤的生物学证据可能有用。选择真正能从手术中获益的患者应考虑三个因素，即患者的临床和功能状态、全身疾病状态以及颅内转移瘤的特征。鉴于癌症患者总生存期的改善部分归因于针对全身疾病的有效靶向治疗的出现，人们对脑转移瘤的局部治疗重新产生了兴趣。手术切除目前是脑转移瘤治疗手段中的一种有价值的工具，但也已成为一种可影响这些患者治疗策略的诊断和决策工具。
