Berghoff Anna S, Preusser Matthias
Clinical Division of Oncology, Department of Medicine and CNS Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Clinical Division of Oncology, Department of Medicine and CNS Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Handb Clin Neurol. 2018;149:57-66. doi: 10.1016/B978-0-12-811161-1.00004-9.
Systemic therapy is an important backbone in the multimodal treatment approach of brain metastases. However, the blood-brain barrier or, more correctly, the blood-tumor barrier, as the properties of tumor-associated vessels differ from the physiologic state, potentially limits the passage of systemic drugs. Indeed, several preclinical and clinical investigations showed that the distribution of drugs is very heterogeneous within a given brain metastasis, despite the contrast enhancement in magnetic resonance imaging. Brain metastases may show lower intratumoral concentrations of some drugs as compared to extracranial tumor sites, resulting in mixed responses. Therefore, a more profound understanding of the role of the blood-brain/blood-tumor barrier is needed to effectively formulate clinical trial approaches on systemic therapy options in patients with brain metastases.
全身治疗是脑转移瘤多模式治疗方法的重要支柱。然而，血脑屏障，或者更准确地说，血肿瘤屏障，由于肿瘤相关血管的特性不同于生理状态，可能会限制全身药物的通过。事实上，多项临床前和临床研究表明，尽管磁共振成像有对比增强，但在给定的脑转移瘤内，药物分布非常不均匀。与颅外肿瘤部位相比，脑转移瘤可能显示某些药物的瘤内浓度较低，从而导致混合反应。因此，需要更深入地了解血脑/血肿瘤屏障的作用，以便有效地制定针对脑转移瘤患者全身治疗选择的临床试验方法。
