Mehta Minesh P, Ahluwalia Manmeet S
From the Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD; Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH.
Am Soc Clin Oncol Educ Book. 2015:e99-104. doi: 10.14694/EdBook_AM.2015.35.e99.
The overall local treatment paradigm of brain metastases, which includes whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS), continues to evolve. Local therapies play an important role in the management of brain metastases. The choice of local therapy depends on factors that involve the patient (performance status, expected survival, and age), the prior treatment history, and the tumor (type and subtype, number, size, location of metastases, and extracranial disease status). Multidisciplinary collaboration is required to facilitate an individualized plan to improve the outcome of disease in patients with this life-limiting complication. There has been concern about the neurocognitive effects of WBRT. A number of approaches that mitigate cognitive dysfunction, such as pharmacologic intervention (memantine) or a hippocampal-sparing strategy, have been studied in a prospective manner with WBRT. Although there has been an increase in the use of SRS in the management of brain metastases in recent years, WBRT retains an important therapeutic role.
脑转移瘤的整体局部治疗模式，包括全脑放疗（WBRT）和立体定向放射外科治疗（SRS），仍在不断发展。局部治疗在脑转移瘤的管理中发挥着重要作用。局部治疗的选择取决于多种因素，包括患者因素（体能状态、预期生存期和年龄）、既往治疗史以及肿瘤因素（类型和亚型、数量、大小、转移灶位置和颅外疾病状态）。需要多学科协作以制定个体化方案，从而改善患有这种危及生命并发症的患者的疾病预后。人们一直担心全脑放疗的神经认知效应。一些减轻认知功能障碍的方法，如药物干预（美金刚）或海马体保留策略，已在前瞻性研究中与全脑放疗联合进行了探讨。尽管近年来立体定向放射外科治疗在脑转移瘤管理中的应用有所增加，但全脑放疗仍保留着重要的治疗作用。
