Naren Ramakrishna, University of Florida Health Cancer Center at Orlando Health, Orlando; Jennifer Levinson, Ponte Vedra Beach, FL; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Sarat Chandarlapaty and Shanu Modi, Memorial Sloan Kettering Cancer Center; Francisco J. Esteva, New York University Langone Medical Center, New York; Jeffrey J. Kirshner, Hematology/Oncology Associates of Central New York, East Syracuse, NY; Jennie R. Crews, Seattle Cancer Care Alliance, Seattle, WA; Nancy E. Davidson, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Sharon H. Giordano, University of Texas MD Anderson Cancer Center, Houston; Debra A. Patt, Texas Oncology, Austin, TX; Ian E. Krop, Eric P. Winer, and Nancy U. Lin, Dana-Farber Cancer Institute, Boston, MA; and Jane Perlmutter, Ann Arbor, MI.
J Clin Oncol. 2018 Sep 20;36(27):2804-2807. doi: 10.1200/JCO.2018.79.2713. Epub 2018 Jun 25.
Purpose To update the formal expert consensus-based guideline recommendations for practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2-positive advanced breast cancer to 2018. Methods An Expert Panel conducted a targeted systematic literature review (for both systemic treatment and CNS metastases) and identified 622 articles. Outcomes of interest included overall survival, progression-free survival, and adverse events. In 2014, the American Society of Clinical Oncology (ASCO) convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts, and conducted a systematic review of the literature. When that failed to yield sufficiently strong quality evidence, the Expert Panel undertook a formal expert consensus-based process to produce these recommendations. ASCO used a modified Delphi process. The panel members drafted recommendations, and a group of other experts joined them for two rounds of formal ratings of the recommendations. Results Of the 622 publications identified and reviewed, no additional evidence was identified that would warrant a change to the 2014 recommendations. Recommendations Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment in a clinical trial, and/or palliative care. Clinicians should not perform routine magnetic resonance imaging to screen for brain metastases, but rather should have a low threshold for magnetic resonance imaging of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer. Additional information is available at www.asco.org/breast-cancer-guidelines .
目的 将针对人表皮生长因子受体 2 阳性晚期乳腺癌患者脑转移管理的实践肿瘤学家和其他人员的正式专家共识为基础的指南建议更新至 2018 年。
方法 一个专家小组进行了有针对性的系统文献复习（包括全身治疗和中枢神经系统转移），并确定了 622 篇文章。感兴趣的结果包括总生存期、无进展生存期和不良事件。2014 年，美国临床肿瘤学会（ASCO）召集了一组肿瘤内科、放射肿瘤学、指南实施和宣传专家，并对文献进行了系统回顾。当这未能产生足够有力的高质量证据时，专家小组进行了正式的专家共识为基础的过程，以制定这些建议。ASCO 使用了改良 Delphi 过程。小组成员起草了建议，一组其他专家也加入了他们，对建议进行了两轮正式评分。
结果 在确定和审查的 622 篇出版物中，没有发现任何其他证据需要改变 2014 年的建议。
建议 有脑转移的患者应接受适当的局部治疗和全身治疗，如果有指征的话。局部治疗包括手术、全脑放疗和立体定向放射外科。治疗取决于患者预后、症状存在、可切除性、转移的数量和大小、既往治疗以及转移是否为弥漫性等因素。其他选择包括全身治疗、最佳支持治疗、参加临床试验和/或姑息治疗。临床医生不应该常规进行磁共振成像来筛查脑转移，而是应该有较低的脑磁共振成像阈值，因为 HER2 阳性晚期乳腺癌患者中脑转移的发生率很高。更多信息可在 www.asco.org/breast-cancer-guidelines 上获得。
