Sinha R, Sage W, Watts C
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
Eur J Surg Oncol. 2017 Jul;43(7):1173-1185. doi: 10.1016/j.ejso.2016.10.006. Epub 2016 Oct 27.
Concepts in the management of brain metastases are evolving. Until recently, brain metastases have been considered as a homogenous condition, managed with whole brain radiotherapy, surgical resection for large lesions and stereotactic radiosurgery for smaller lesions. Increasingly, specific systemic medical therapies are being used to treat brain metastases based on the primary site of disease. This disease specific management is causing a change in perspective about brain metastases and has led to improved survival for patients with primary disease subtypes amenable to tailored medical therapies. We review the recent literature to present evidence for the use of subtype specific medical therapies, advances in surgical resection techniques and stereotactic radiosurgery as the primary treatment modalities. The decline in use of whole brain radiotherapy as first line treatment is also discussed. Based on the recent literature, we propose a new management algorithm to reflect the progress in available options for tailoring disease specific treatments and support the change in paradigm to consider brain metastases as separate disease states based on the primary site of cancer rather than as a homogenous entity.
脑转移瘤的管理理念正在不断演变。直到最近，脑转移瘤还被视为一种同质化疾病，采用全脑放疗、对大病灶进行手术切除以及对较小病灶进行立体定向放射外科治疗。越来越多地，基于疾病的原发部位，特定的全身药物疗法被用于治疗脑转移瘤。这种针对疾病特定类型的管理正在改变人们对脑转移瘤的看法，并提高了适合采用定制化药物疗法的原发性疾病亚型患者的生存率。我们回顾了近期文献，以展示使用亚型特异性药物疗法、手术切除技术进展以及立体定向放射外科作为主要治疗方式的证据。还讨论了全脑放疗作为一线治疗的使用减少情况。基于近期文献，我们提出一种新的管理算法，以反映在定制疾病特异性治疗可用选项方面的进展，并支持将范式转变为基于癌症原发部位将脑转移瘤视为不同疾病状态，而非同质化实体。
