Wolf Amparo, Kondziolka Douglas
Department of Neurosurgery, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, NY, United States.
Department of Neurosurgery, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, NY, United States.
Handb Clin Neurol. 2018;149:129-135. doi: 10.1016/B978-0-12-811161-1.00010-4.
Stereotactic radiosurgery has revolutionized the management of brain metastases. It delivers focused, highly conformal, ionizing radiation to a tumor delineated using high-resolution imaging, with low toxicity to adjacent brain structures. Randomized controlled and prospective trials have demonstrated a survival advantage and high local control rates after stereotactic radiosurgery for metastatic disease to the central nervous system, including for up to 10 brain metastases. Its minimal-access nature makes it an attractive alternative to surgical resection. Furthermore, in addition to chemotherapy, newer targeted therapies and immunotherapies with improved side-effect profiles allow for the concurrent delivery of systemic therapy with radiosurgery, with possible additive or synergistic effects, expediting the treatment of both extracranial and intracranial disease. The modern management of brain metastasis patients should include consideration of routine staging and surveillance magnetic resonance imaging scans in patients with higher-stage cancer to detect intracranial metastases earlier and treat promptly with radiosurgery in order to prevent the development of neurologic symptoms and the need for surgical resection.
立体定向放射外科彻底改变了脑转移瘤的治疗方式。它利用高分辨率成像确定肿瘤位置，将聚焦的、高度适形的电离辐射传递至肿瘤，对邻近脑结构的毒性较低。随机对照试验和前瞻性试验表明，对于中枢神经系统转移性疾病，包括多达10个脑转移瘤，立体定向放射外科术后具有生存优势和较高的局部控制率。其微创性质使其成为手术切除的有吸引力的替代方法。此外，除了化疗，具有改善副作用谱的新型靶向治疗和免疫治疗允许与放射外科同时进行全身治疗，可能产生相加或协同效应，加快颅外和颅内疾病的治疗。脑转移瘤患者的现代治疗应包括对晚期癌症患者进行常规分期和监测磁共振成像扫描，以便更早地检测颅内转移瘤，并及时进行放射外科治疗，以预防神经症状的出现和手术切除的必要性。
