Szadurska Agnieszka, Pluta Elżbieta, Walasek Tomasz, Blecharz Paweł, Jakubowicz Jerzy, Mituś Jerzy W
Radiotherapy Department, Centre of Oncology - M. Skłodowska-Curie Memorial Institute, Cracow Branch, Poland.
Clinic of Gynaecological Oncology, Centre of Oncology - M. Skłodowska-Curie Memorial Institute, Cracow Branch, Poland.
Contemp Oncol (Pozn). 2016;20(6):430-435. doi: 10.5114/wo.2016.65601. Epub 2017 Jan 12.
This article presents methods and results of surgical treatment and radiation therapy of brain metastases in breast cancer patients (brain metastases from breast cancer BMF-BC). Based on the literature data, it was shown that patients with single BMF-BC, aged less than 65 years, with Karnofsky score (KPS) of 70 or more and with cured or controlled extracranial disease are the best candidates to surgical treatment. Irrespective of the extracranial disease control status, there are indications for surgery in patients with symptomatic mass effect (tumour diameter larger than 3 cm) and patients with obstructive hydrocephalus from their BMF-BC. Stereotactic radiosurgery (SRS) has some advantages over surgery, with similar effectiveness: it may be used in the treatment of lesions inaccessible to surgery, the number of lesion is not a limiting factor if each lesion is small (< 3) and adequate doses can be delivered, it is not contraindicated in patients with active extracranial disease, it does not interfere with ongoing systemic treatment, and it does not require general anaesthesia or hospitalisation. A disadvantage of SRS, as compared to whole brain radiotherapy (WBRT), in patients with BMF-BC is the possibility of subsequent development of new lesion in the non-irradiated field. Thus the majority of the BMF-BC patients are not good candidates to surgery or SRS; WBRT alone or combined with a systemic treatment still plays a major role in the treatment of these patients.
本文介绍了乳腺癌患者脑转移瘤（乳腺癌脑转移，BMF-BC）的手术治疗和放射治疗方法及结果。基于文献数据表明，单发BMF-BC、年龄小于65岁、卡诺夫斯基评分（KPS）为70分或更高且颅外疾病已治愈或得到控制的患者是手术治疗的最佳人选。无论颅外疾病控制情况如何，有症状性占位效应（肿瘤直径大于3 cm）的患者以及因BMF-BC导致梗阻性脑积水的患者都有手术指征。立体定向放射外科（SRS）与手术相比有一些优势，效果相似：它可用于治疗手术无法触及的病变，如果每个病变较小（< 3 cm）且能给予足够剂量，病变数量不是限制因素，对有活跃颅外疾病的患者无禁忌，不干扰正在进行的全身治疗，且不需要全身麻醉或住院。与全脑放疗（WBRT）相比，BMF-BC患者接受SRS的一个缺点是在未照射区域可能随后出现新病变。因此，大多数BMF-BC患者不是手术或SRS的合适人选；单纯WBRT或与全身治疗联合仍在这些患者的治疗中起主要作用。
