Department of Neuro-Oncology, University of Turin, Via Cherasco 15, 10126 Turin, Italy.
Future Oncol. 2018 Jul;14(17):1765-1774. doi: 10.2217/fon-2017-0630. Epub 2018 Jun 29.
Breast cancer (BC) is a heterogeneous disease. Different subtypes of BC exhibit a peculiar natural history, metastatic potential and outcome. Stereotactic radiosurgery is the most used treatment for brain metastases (BM), while surgery is reserved for large and symptomatic lesions. Whole-brain radiotherapy is employed in multiple BM not amendable to radiosurgery or surgery, and it is not employed any more following local treatments of a limited number of BM. A critical issue is the distinction from pseudoprogression or radionecrosis, and tumor regrowth. Considering the increase of long-term survivors after combined or novel treatments for BM, cognitive dysfunctions following whole-brain radiotherapy represent an issue of utmost importance. Neuroprotective drugs and innovative radiotherapy techniques are being investigated to reduce this risk of cognitive sequelae. Leptomeningeal disease represents a devastating complication, either alone or in association to BM, thus targeted therapies are employed in HER2-positive BC brain and leptomeningeal metastases.
乳腺癌（BC）是一种异质性疾病。不同亚型的 BC 表现出独特的自然病史、转移潜能和结局。立体定向放射外科是治疗脑转移瘤（BM）最常用的方法，而手术则保留用于大的和有症状的病变。全脑放疗适用于不能行放射外科或手术治疗的多发性 BM，并且在对有限数量的 BM 进行局部治疗后不再使用。一个关键问题是与假性进展或放射性坏死和肿瘤复发相区别。考虑到联合或新型 BM 治疗后长期幸存者的增加，全脑放疗后认知功能障碍是一个极其重要的问题。正在研究神经保护药物和创新的放射治疗技术，以降低认知后遗症的风险。脑膜疾病是一种破坏性的并发症，无论是单独发生还是与 BM 相关，因此针对 HER2 阳性 BC 脑和脑膜转移瘤采用了靶向治疗。
