Patel Dhruv M, Agarwal Nitin, Tomei Krystal L, Hansberry David R, Goldstein Ira M
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2015 Aug;84(2):412-9. doi: 10.1016/j.wneu.2015.03.052. Epub 2015 Apr 1.
For patients with cerebral metastases that are limited in number, surgical resection followed by whole-brain radiation therapy is the standard of care. In addition, for high-grade gliomas, maximal surgical resection followed by local radiotherapy is considered the optimal treatment. Radiation is known to impair wound healing, including healing of surgical incisions. Radiotherapy shortly after surgical resection would be expected to minimize the opportunity for tumor regrowth or progression. Owing to these competing interests, the purpose of this study was to shed light on the optimal timing of radiotherapy after surgical resection of brain metastasis or high-grade gliomas.
A review of the literature was conducted on the following topics: radiation and wound healing, corticosteroid use and wound healing, radiotherapy for tumor control for cerebral metastases and high-grade gliomas, and whole-brain radiation therapy or focal radiotherapy after craniotomy with focus on the timing of radiotherapy after surgery.
In animal models, wound integrity and healing was less impaired by radiotherapy administered 1 week after surgery. In humans, this timing would be expected to be significantly longer, on the order of several weeks.
Given the limited literature, insufficient conclusions can be drawn. However, animal data suggest a period of at least 1 week (but it is likely several weeks in humans) is necessary for reconstitution of wound strength before initiation of radiation therapy. A randomized prospective study is recommended to understand better the effect of the timing of radiation therapy following surgical intervention for brain metastasis or high-grade gliomas.
对于脑转移瘤数量有限的患者，手术切除后行全脑放射治疗是标准的治疗方法。此外，对于高级别胶质瘤，最大程度的手术切除后行局部放疗被认为是最佳治疗方案。已知放疗会损害伤口愈合，包括手术切口的愈合。手术切除后不久进行放疗有望将肿瘤复发或进展的机会降至最低。由于存在这些相互矛盾的因素，本研究的目的是阐明脑转移瘤或高级别胶质瘤手术切除后放疗的最佳时机。
对以下主题进行了文献综述：放疗与伤口愈合、皮质类固醇的使用与伤口愈合、脑转移瘤和高级别胶质瘤的肿瘤控制放疗，以及开颅术后的全脑放射治疗或局部放疗，重点关注术后放疗的时机。
在动物模型中，术后1周进行放疗对伤口完整性和愈合的损害较小。在人类中，预计这个时间会显著延长，大约为数周。
鉴于现有文献有限，无法得出充分的结论。然而，动物数据表明，在开始放疗前，至少需要1周时间（但在人类中可能为数周）来恢复伤口强度。建议进行一项随机前瞻性研究，以更好地了解脑转移瘤或高级别胶质瘤手术干预后放疗时机的影响。
