Di Lorenzo Rodica, Ahluwalia Manmeet S
Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, CA-51, Cleveland, OH 44195, USA.
Ther Adv Med Oncol. 2017 Dec;9(12):781-796. doi: 10.1177/1758834017736252. Epub 2017 Nov 15.
Brain metastases (BM) occur in 20-40% of patients with cancer and 60-75% of patients with BM become symptomatic. Due to an aging population and advances in the treatment of primary cancers, patients are living longer and are more likely to experience complications from BM. The diagnosis of BM drastically worsens long-term survival rates, with multiple metastases being a poor prognostic factor. Until recently, the mainstay of treatment consisted of stereotactic radiosurgery (SRS), surgical resection, whole brain radiation therapy (WBRT), or a combination of these modalities. Systemic chemotherapy has been felt largely ineffective in the treatment of BM due to the presence of the blood-brain barrier (BBB), which includes efflux pumps on brain capillaries. Over the past decade however, researchers have identified therapeutic agents that are able to cross the BBB. These findings could make a multimodality treatment approach possible, consisting of surgery, radiation, immunotherapy, and targeted therapy, which could lead to better disease control in this patient population and prolong survival. In this review, we discuss present evidence on available targeted therapies and their role in the treatment of BM from primary tumors with the highest prevalence of central nervous system (CNS) involvement, specifically non-small cell lung cancer (NSCLC), breast cancer melanoma, and renal cell carcinoma.
脑转移瘤（BM）发生于20% - 40%的癌症患者中，且60% - 75%的BM患者会出现症状。由于人口老龄化以及原发性癌症治疗的进展，患者寿命延长，更有可能出现BM相关并发症。BM的诊断会显著降低长期生存率，多发转移是一个不良预后因素。直到最近，治疗的主要方法包括立体定向放射外科（SRS）、手术切除、全脑放射治疗（WBRT）或这些方法的联合应用。由于血脑屏障（BBB）的存在，包括脑毛细血管上的外排泵，全身化疗在BM治疗中一直被认为效果不佳。然而在过去十年中，研究人员已经确定了能够穿越BBB 的治疗药物。这些发现可能使多模式治疗方法成为可能，包括手术、放疗、免疫治疗和靶向治疗，这可能会更好地控制该患者群体的疾病并延长生存期。在本综述中，我们讨论了现有靶向治疗的证据及其在治疗中枢神经系统（CNS）受累发生率最高的原发性肿瘤BM中的作用，特别是非小细胞肺癌（NSCLC）、乳腺癌、黑色素瘤和肾细胞癌。
