Pruitt Amy A
Continuum (Minneap Minn). 2017 Dec;23(6, Neuro-oncology):1580-1600. doi: 10.1212/CON.0000000000000551.
Neurologic problems resulting from systemic cancer metastases to brain parenchyma, dura, spinal cord, and leptomeninges are among the most common types of consultations addressed by neurologists. With patients surviving longer from systemic cancer, along with the rapidly evolving therapeutic options, the treatment of these devastating complications has become both more effective and more complicated. This article reviews current patterns of metastatic disease and the increasingly nuanced landscape of evolving therapies, their complications, and their impact on quality of survival.
Targeted therapies with tyrosine kinase inhibitors and immune checkpoint inhibitors and cytotoxic therapies directed at disease-specific chemosensitivity patterns have dramatically improved the prognosis of non-small cell lung cancer, melanoma, and breast cancer, but have led to some novel complications and altered recurrence patterns. Clinical trials suggest the superiority of hippocampal-avoidance radiation fields and the use of stereotactic radiosurgery over whole-brain radiation therapy to minimize long-term cognitive consequences of radiation therapy. Emerging data document tolerable safety when brain radiation is combined with immunotherapy. Chemotherapy can be a first-line treatment for some inoperable brain metastases, eliminating or deferring whole-brain radiation therapy. Stereotactic body radiation therapy is a new technique of radiation used for spinal and epidural metastases that spares spinal cord tissue while ablating tumors.
Metastases to the nervous system remain devastating, but their prognosis and therapies are more heterogeneous than previously appreciated. Neurologists now can offer more personalized prognostic information based on new stratification criteria, can predict drug complications relevant to the nervous system, and can provide critical partnership in the multidisciplinary effort to balance effective longer-term disease control with treatment-related adverse consequences.
系统性癌症转移至脑实质、硬脑膜、脊髓和软脑膜所导致的神经系统问题是神经科医生最常处理的会诊类型之一。随着系统性癌症患者生存期延长，以及治疗选择迅速发展，这些严重并发症的治疗变得更加有效但也更加复杂。本文综述了转移性疾病的当前模式以及不断演变的治疗方法、其并发症及其对生存质量的影响这一日益细微的情况。
酪氨酸激酶抑制剂和免疫检查点抑制剂的靶向治疗以及针对疾病特异性化疗敏感性模式的细胞毒性治疗显著改善了非小细胞肺癌、黑色素瘤和乳腺癌的预后，但也导致了一些新的并发症并改变了复发模式。临床试验表明，与全脑放射治疗相比，海马回避放射野和立体定向放射外科手术在将放射治疗的长期认知后果降至最低方面具有优势。新出现的数据表明，脑部放射与免疫治疗联合使用时安全性可耐受。化疗可作为一些无法手术切除的脑转移瘤的一线治疗方法，消除或推迟全脑放射治疗。立体定向体部放射治疗是一种用于脊髓和硬膜外转移瘤的放射新技术，可在消融肿瘤的同时保护脊髓组织。
神经系统转移瘤仍然具有毁灭性，但其预后和治疗比以前认识到的更加多样化。神经科医生现在可以根据新的分层标准提供更个性化的预后信息，预测与神经系统相关的药物并发症，并在多学科努力中提供关键合作，以平衡有效的长期疾病控制与治疗相关的不良后果。
