Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, 4102, Australia.
University of Queensland, Brisbane, Queensland, Australia.
BMC Cancer. 2017 Nov 15;17(1):768. doi: 10.1186/s12885-017-3672-z.
The routine use of adjuvant whole brain radiotherapy (AWBRT) after surgery or stereotactic radiosurgery is now discouraged by a number of international expert panels. Three decades of randomised studies have shown that, although AWBRT improves radiological measures of intracranial disease control, the clinical benefit is unclear and it is also associated with inferior quality of life and neurocognitive function. The number of patients with melanoma in these trials was low, but data suggesting that treatment-related side effects should vary according to histology of the primary malignancy are lacking. For metastatic melanoma, the role of AWBRT to control microscopic disease in the brain is also a less relevant concern because systemic therapies with intracranial activity are now available. Whether AWBRT is useful in select patients deemed at high risk of neurologic death remains undefined.
目前,许多国际专家小组不建议在手术后或立体定向放射外科手术后常规使用辅助全脑放疗(AWBRT)。三十年来的随机研究表明,尽管 AWBRT 改善了颅内疾病控制的影像学指标,但临床获益尚不清楚,而且还与较差的生活质量和神经认知功能有关。这些试验中黑色素瘤患者的数量较少,但缺乏数据表明与原发性恶性肿瘤的组织学相关的治疗相关副作用应该有所不同。对于转移性黑色素瘤,AWBRT 控制脑内微小疾病的作用也不太重要,因为现在有颅内活性的全身治疗方法。AWBRT 是否对被认为有神经死亡高风险的特定患者有用仍未确定。